4309 30TH DR SE 2019-01-08 - Laserfiche WebLink

LECTRICAL PERI v 3III A_IICATIIO CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT, WA 98201 (P)425-257-8810 FAX FAX 425-257-8857 j (E)everetteps@everettwagov j www.everettwa.gov/permits .tiPROJECT ADDRESS• 14- '. {�f BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: EI SFR-DETACHED 0 SFR-ATTACHED El DUPLEX 0 MULTI-FAMILY-#OF UNITS: El COMMERCIAL USE OF BUILDING: ELECTR CAL.AP LIGATJONiR F'9)[ i AT!O1id... • CONTRACT PRICE OF WORK: NUMBER OF DEVICES(if low voltage): FIRE ALARM? CI YES D NO ASSOCIATED BUILDING PERMIT#(if applicable): C../ t,00 `" DESCRIPTION OF WORK: Vi„)`I v,) CONTACT OWNER NAME: f)I It is TENANT NAME(If Commercial): OWNER MAILING ADDREA: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME. €l __. iG`Ly y �' 1/0,4 �� 'W..`f0 .a..LA l.,. , .. . _..�..,. r ..r ....._........,�......... ......d_.... ,��, CONTRACTOR ADDRESS: '1 sree rf e212)- 2 KI l AAA_ `- CITY Kato- STATE 1/11A- ZIP°1032-- CONTRACTOR PHONE:(2, V (0051 ,CONTRACTOR EMAIL: CONTRACTOR LIG.MREQUIRED) Q /I)9(04 {;..g CITY OF EVERETT BUSINESS LIC #(REQUIRED):VI KKLP PRIMARY CONTACT: El OWNER Cl CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT:T hereby certify that!have read and examined this application and know the same to be true end correct.All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not The granting of a pen-nit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That lam authorized by the owner of this properly to perform the work for which application Is made and I comply with the State Contractors Law 18.27 ROW and 296.200 WAC: City of Everett Official Use Only FEE O PERMIT:# Sia (0 -2,50 OwnerlAutfiorized Agent Signature Date (Revised 10112/2015)