Laserfiche WebLink
LLECTRICAL PERMIT APPLICATION <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: 'I12Q tt Ak. , w qg a p <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 2.:erg gJ SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: VCOMMERCIAL <br /> USE OF BUILDING: . V -� <br /> LECTRICA APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: 15, cot <br /> NUMBER OF DEVICES(if low oltage): /, <br /> FIRE ALARM? 0 YES rirN• <br /> ASSOCIATED BUILDING PER T pplicable): $m)y-Ong <br /> DESCRIPTION OF WORK: Iles-Er cpk4 c2Of -EC-AM i' 1 ypr'DUW-1 Lot <br /> CONTACT INFORMATION.. <br /> OWNER NAME: N)I )flV si-nierit L.i M;}. TENANT NAME(If Commercial):1le� 130 G SP <br /> OWNER MAILING ADDRESS: STREET 13 i/ag 4541LRT IA) <br /> cm( MtkItiI ir9 STATE wZIP 92..75 <br /> OWNER PHONE: 2 *- $ ' QiOWNER EMAIL: c <br /> hm Anna, •Got v <br /> CONTRACTOR NAME: A'Q1i1Q Wt f'44. electric. <br /> CONTRACTOR ADDRESS: STREET !q5 ? ••• <br /> J\/ 1 U e, 6g <br /> CITY1// �/ei STATE lidry ZIP / "r <br /> CONTRACTOR PHONE: 1.125-331-g d�Q�Q CONTRACTOR EMAIL: Alpha.ea c2e-. ustr m,( e <br /> CONTRACTOR <br /> ONTACTOR LIC.#(REQUIRED): ALPHA O E R tO l Kw,wl.,_0....... .... :.._....Cv:.ITY.,._.OF_..EVE..:RE.,wTT BUSIN...ESS LIC.#RE..yQUIR D <br /> :D13 � <br /> r <br /> PRIMARY CONTACT: 0 OWNER I "CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT, ', �u <br /> NAME: CONTACT PHONE: 42,5'42,5' .3 L ( � 21l„n9' <br /> / o-tirt ,rne, CONTACT EMAIL: Na GI.Y‘@G(ilV <br /> 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 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 I am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> J"drop. _J.5. E t,4oct - 7-0 <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />