Laserfiche WebLink
"ow. <br /> LECTRICAL PERMIT APLICATION <br /> _ CITY 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: 3 L1 (c( Oat Ice. , A O'f._ p <br /> BUILDING11.AREA(if residential,new construction,remodel,or addition) Qe I( Q_v\ , SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> _ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ '0 0(� <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: -g de(); 2 0 ®,w,n C.rc u i s r <br /> b6444, G pc( Gtni'1 2 b l+ <br /> CONTACT INFORMATION - <br /> OWNER NAME: TENANT� NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 L� 1 Oo ,4 <br /> CITY r Eve €- I STATE �n 5 A- ZIP 18 Z 0 t <br /> 1 <br /> OWNER PHONE:(I LS.) 61-71--!q;6 OWNER EMAIL: '- <br /> CONTRACTOR NAME: DCi d Z C#{ oI( e+;"\f c(, Q LL C <br /> CONTRACTOR ADDRESS: STREET 301 Pkoc d t S4-; p� <br /> CITY EVC- re-A-4 STATE w ' ' ZIP `&? 3 <br /> CONTRACTOR PHONE: ( ZS 232-- \3 0 CONTRACTOR EMAIL: d <z.eC*(t L(2 9 t'v ov I.C-OM <br /> CONTRACTOR LIC.#(REQUIRED): CDG\ 2e e5 S Z9 OH CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5&t q 8 <br /> PRIMARY CONTACT: ©OWNER CONTRACTOR»v`CI OTHER(Please Specify) <br /> CONTACT <br /> �"H_ <br /> CONTACT NAME: CONTACT PHONE: Pi& t f Zlc- 2, ?� 'Z --('30( <br /> CONTACT EMAIL: 1 J ze t eL(Y�c mom' <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 t 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4i, <br /> PERMIT# <br /> 04118 t tbOS --6S 3 <br /> Owner/Authorized Agent Sign re Da (Revised 10/12/2015) <br />