5529 BROADWAY 2019-02-05 - Laserfiche WebLink

ELECTRICAL PERMIT APICATION "IIIP/Aa,V---A v - 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 PROJECTSITE INF©RMATI PROJECT ADDRESS: S 5 as Bro cka,o o' ere) WA OJ 7 3,:o3 BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: SFR-DETACHE I% ,:FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDIN 14,,S id`..X1C' ELECTRICAL APPLICATION INFORMATICM. ..ry CONTRACT PRICE OF WORK:$ II(p K NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES NO ASSOCIATED BUILDING PERMIT#(if applicable): 0110 i—O a3 DESCRIPTION OF WORK: E t.e.41 Z(A\ WiY'itn J I a.0.0 A y"-4- 0..C7t Ci �„VAN\ gbh Se-OW AI t4VP\V g CONTACT INFORMATION OWNER NAME: S•rz5 Q ick\04\ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET PI`(1`B A4.p toa\ S(-51 t'e CITY Lake, �'eNtvl STATE W a c ZIP 18.M-16. OWNER PHONE: 4 a9Ct OS a0 OWNER EMAIL: bOc.o 1 hD1Y S v ' \.0.004CONTRACTOR NAME: So CONTRACTOR ADDRESS: STREETC I\\4,1"t `1, S� J'.. `- ` CITY vycx1 o(MstsL STATE w(Z1 ZIP CfS as.9 CONTRACTOR PHONE:°ti'as 34+ ) y a.15 CONTRACTOR EMAIL: J\fl SO\t S 1. I J Imct ik.COCONTRACTOR LIC.#(REQUIRED): SCA'S e\ "64 R d q CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 OWNER *CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: UzyzA, Sa\is CONTACT PHONE: as 3y y (a,'1 S CONTACT EMAIL: �2ht'1Sa‘IS I. t 3yv o \ .a)� 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 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 Official Use Only PETo # E -t Zil Owner/Auth40.e.U4.. ed Agent Signature Date (Revised 9/23/2016)