3511 BROADWAY 2019-01-17 - Laserfiche WebLink

LLILCECCTRICAL PE AFILICATION I�!►' 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.govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: I ) Dkp(A)fA7 �/� �1 �' '3i(9 BUILDING AREA(if residential,new construction,remodel,or addition) SF • BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: .COMMERCIAL USE OF BUILDING: (. t�j`( j O1.) ELECTRICAL APPLICATION iNIFORMATION CONTRACT PRiCE OF WORK:$ p DO NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES \J1110 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: K 71 Mf et&F--P COMP()rr OA) �� (�-,goy (o L-eht,f4) CONTACTINFORMATION- = OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET cn, STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET '34, Li 15 Cr n CITY irAk t--6) -E47" � STATE V4 ZIP y8°�rf CONTRACTOR PHONE: 7 Z t7 3 £{x'7.7 CONTRACTOR EMAIL: •-f y",,,1/),e/ic-/-,rlllr c� /2 IL�V.; CONTRACTOR LiC #(REQUIRED): (_ 'V/P5w,. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT:—❑OWNER CONTRACTOR ❑OTHER(Please Specify) — CONTACT NAME: CONTACT PHONE: e,gc•-7'734--77 ,V'f \ 5o,V J CONTACT EMAIL: AGREEMENT:T 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 gov ening 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 1 am 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 Oficial Use Only FEE q- . 0 PERMIT# Owner/Authorized Agent Signature ate (Revised 10/12/2015)