5815 HIGHWAY PL 2019-01-08 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov( www.everettwa.gov/permits PROJECT SITE INFORMAATION PROJECT ADDRESS: 5$1 - BUILDING AREA(if residential,new;con ruction;remodel,or addition) -- 1 SF BUILDING TYPE: 0 SFR-DETACHED ,I SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$111,5(0 NUMBER OF DEVICES;:;(if low voltage): FIRE ALARM? YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: MtW i OD AMP ..SF• :CONTACT INFORMATION OWNER NAME: Vtkeiki C Vfdslt. TENANT NAME(IiCommerch!): OWNER MAILING ADDRESS: STREET 2,1300 Vl St,Y D. 51 E 10 CITY WOOC11 ill ' _... ..--__ _STATE_'. „/f -.ZIP goo _._.. OWNER PHONE: OWNEREMAIL: � ,��_�r�� CONTRACTOR NAME: Vita "C" ( 11 t4 L3 c. CONTRACTOR ADDRESS STREET ea eitOr 70 9 CITY COViikkklyit -.... _. _ STATE WA_. ZIP ,chtotiZ... CONTRACTOR PHONE:ZS 3-(j31 Ti OK, ' eat ICONTRACTOR EMAIL: penmtA-Se pVbV dm L MLvtt- CONTRACTOR LIC:#(REQUIRED): 'Peal 6.1.i 3(.t,__ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):3( %VI PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: 3Nin n A AAA CONTACT PHONE: `ZS3',( , ( -7-ropC I OZ.S , CONTACT EMAIL:. 92.1'Yll praitcd4tE- Le -nic'stie+ AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct, All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# • - - _LiLI — 1$-11 E llo g-- 12) Owner/Authorized Agent Signature Date (Revised 9/23/2016)