4106 CLIFF DR 2019-01-25 - Laserfiche WebLink

I ELECTRICAL PERMIT APPLICATION j CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4106 cliff dr everett wa 98203 BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ID SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: sfr ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 700 NUMBER OF DEVICES(if low voltage): 1 FIRE ALARM? ❑YES ®NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: line volt for HP, control for HP CONTACT INFORMATION OWNER NAME: Barry herem TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4106 cliff dr city everett STATE wa ZIP 98203 OWNER PHONE: 425 257 2056 OWNER EMAIL: barryherem@gmail.com CONTRACTOR NAME: axiom hvac CONTRACTOR ADDRESS: STREET 2232 broadway crry everett STATE wa ZIP 98201 CONTRACTOR PHONE: 425 879 5351 CONTRACTOR EMAIL: daron@axiomnw.com CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 54729 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 425 879 5351 daron CONTACT EMAIL:daron@axiomnw.com 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 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 Official Use Only PERMIT# Aiiii° if� z� 7 En lb L\ Owner/Authorized Agent Signature Date (Revised 9/23/2016)