220 DORN AVE 2019-01-28 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION '11411POI144WCITY OFEVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 982011 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.govlpermits PROJECT SITE IN>Fl RMATION PROJECT ADDRESS: �:F fit ,,tlitor b"vefeht 11119 e g BUILDING AREA(if residential new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED r= DUPLEX 0 MULTI-FAMILY-#OF UNITS: Cl COMMERCIAL USE OF BUILDING: reilatairdr cif iv m. 'dg d. • • ELECTRICAL APPLICATION INFORMATION: CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES(if low voltage): Corn ;e...4,41 ‘,et//e ' f e r:chrA1vv1' FIRE ALARM? 0 YES L 'NO ASSOCIATED BUILDING PERMIT#(if applicable). /9 DESCRIPTION OF WORK: /gt151417 one ,(44,74/ v`e%H, .5 r n azifei 4 :Tea liet c- 6 e-- k, a , ,,vii/l / ife -c ear cAouyity- CONTACT INFORMATION OWNER NAME: gOigN7 f'?t TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1.4ge .Plrg /71/4 / cirr '&P t' STATE 4/1xlr '91 g OWNER PHONE •-9440..7"' 'ger- 93 OWNER EMAIL: ° s,7'., /ivy .6)_9 :` 4,1,1 CONTRACTOR NAME: , /1/44).41 b4c/rPe, 4vt, . CONTRACTOR ADDRESS: STREET //341 X7'4A e y CITY e STATE- A ZIP 9.0 CONTRACTOR PHONE: . 2 I1g CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): /4/CRe5icir'''903 CITY OF EVERETT BUSINESS LIC.#(REG!//RED): 602 PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: reallA CONTACT PHONE: psi~ ._ CONTACT EMAIL: -terry.A fe�f, / corn 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 288:200 WAC City of Everett Official Use Only r PERMIT# :4049 7/72,c-lig E _l3 Owner/Authorized Agent Signature Date (Revised 9/23/2016)