5819 HIGHWAY PL 2019-01-08 - Laserfiche WebLink

i ilftiP ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: SSA 1,40,,,,,„y p I ace. BUILDING AREA(if residential,new conructJon remodel,or addition)' 1SiS 1 SF BUILDING TYPE: 0 SFR-DETACHED , SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION,INFORMATION CONTRACT PRICE OF WORK:$1 IZ NUMBER OF DEVICES(if low voltage): FIRE ALARM? RYES. 0 NO ASSOCIATED BUILDING PERMIT#�(if applicable): DESCRIPTION OF WORK: N J 100 AM' 5 CONTACT'INFORMATION OWNER NAME: V7►C1oc1 G,Ti j ay, TENANT NAME(if'Commercial): OWNER MAILING ADDRESS: STREET 11300 V C 'bry Bt I/0 STE '700 orrY W001114,4 r.ti r- STATE lyjl'f.. P ."t13 7 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ih �C1if CONTRACTOR ADDRESS: STREET (to At -7D$7 /� -...cITY,CAA '�"," STATE WA_ - ....:ZIP �/1042. CONTRACTOR PHONE:ZS 3 1031 11SOX 672 1CONTRACTOR EMAIL. �t►nbpyOVAdM '(_vt4- 1 t" CONTRACTOR LIC.#k(REOUIRED): %CM 81 i.O3C t ICITY OF EVERETT BUSINESS LIC. !(REQUIRED) (W J,7z PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Sl�tt�ruris�. � � 2S3�`031 -77.5'ox !dz8 CONTACT EMAIL ` 1 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 I em 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# . ._._ 140/V\_..--- LI ••••. 1 C6 ill 1 E &'10 r30 Owner/Authorized Agent Signature Date (Revised 9/23/2016)