1333 LOMBARD AVE 2019-02-11 - Laserfiche WebLink

i ELECTRICAL PERMIT APPLICATION NiiCITY 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 0:13 LP M ofem.t Au& BUILDING AREA(if residential,new construction,remodel, or addition) `w SF • BUILDING TYPE: 0 SFR-DETACHED FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: t; J L.sy ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ M091°'NUMBER OF DEVICES(if low voltage): Nat FIRE ALARM? 0 YES 1 O ASSOCIATED BUILDING PERMIT#(if applicable): //!- DESCRIPTION OF WORK: 1r?t1 1 EIV)( V 1ZettQ5 coi Da 5111 &i L oe�{y`1t. j to c- i f4Nct s tt. CONTACT INFORMATION OWNER NAME: 7iW S>ig/PO9 a a . TENANT NAME(If Commercial): ......,— OWNER MAILING ADDRESS: STREET /333 �t0m1' 4.V p� s� CnY EV 6Ra- IfSTATE ZIP 7g z i OWNER PHONE: GAP"920"7 yp OWNER EMAIL: N, - CONTRACTOR NAME: PK.v/ L 61 C., CONTRACTOR ADDRESS: STREET Igz40 e. 4 E cny640-err STATE ZIP p eZ0/ CONTRACTOR PHONE: *57165—7603 CONTRACTOR EMAIL: t 1►2f N(4TS 0&/? O1V'I o2- &''fY7 CONTRACTOR LIC.#(REQUIRED): Pr-SrtE7`yf lee/ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): o%'7 03 PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER(Please Specify) CONTA.1 NAME: ,t//,[` CONTACT PHONE: ??5---Z4 F- 7603 c/G"'/ (/i//N5 CONTACT EMAIL: JAIL N U Jf'c)0 @ A^47' .(2 of 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 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 lam 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 FEE IvC/ PERMIT# .41. ' ( IP/ 16 9//o4E9 - ,,3 •. ner/Au o' ed A,ent S 1nature Date (Revised 10/12/2015)