Laserfiche WebLink
1 <br /> ELECTRICAL PERMIT APPLICATION <br /> /00*,% --_ <br /> CITY OF EVERETT PERMIT SERVICES <br /> �- 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: / 2-0 SE Ir /140(u..,14/4. <br /> BUILDING AREA(if residential,new construction, remodel,or addition) t SF • <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: o ,1 <br /> ELECTRICAL.APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 30190 J%) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: % I t/) I kit 1/c X C- <br /> CONTACT INFORMATION�/Vt-GC ., <br /> OWNER NAME: PJAta. ""t A/J f j � �TENANT NAME(If Commercial): 2i kL; .,Q ) / <br /> OWNER MAILING ADDRESS: STREET .7-7 Jf /t1(77 /%<t 14/1 CO <br /> ) <br /> CITY 1 STATE II t/l//CZIP 7t5,31 %/ <br /> OWNER PHONE: `/`��- 3`T 7� O )3 <br /> ! vfi OWNER EMAIL: JHA/ft 7 ( r./(/t/(�t F((/���! r6l s <br /> CONTRACTOR NAME: �(_ L-/4t-n , �i ,(fic I .�i <br /> CONTRACTOR ADDRESS: STREET 2 F2'3 Zg-j z,Alt-, 5-6 <br /> { CITY ,cyc� (,//A,(44(/ / ( J STATE ZIP '. <br /> CONTRACTOR PHONE:eiLJ-2- -K 6F3 CONTRACTOR EMAIL: --k-Ali;a)...S0 h4SAI-'4.-9 <br /> CONTRACTOR LIC.#(REQUIRED):,\L 2 9)0 ft43 CITY OF EVERETT BUSINESS LIC.# Q <br /> PRIMARY CONTACT: 0 OWNER X CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: . --2 -T - <br /> �.J t)nL tia L CONTACT EMAIL: J/,.�! A 3 m e /1J- 4--..60.."- <br /> AGREEMENT: <br /> .,&v - <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and con-act. All provisions of laws and ordinances governing this <br /> 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 <br /> local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 2 - 50 <br /> PERMIT# <br /> / _______.___ (, E c.gc c —� 22 <br /> Owner/Authorizecy' ent Signature Date (Revised 10/12/2015) <br />