Laserfiche WebLink
4E77 ECTRICAL PERMIT AF : LICATION <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: _.)_7 h <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 3 SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-`#OF UNITS: fa/COMMERCIAL <br /> USE OF BUILDING: ) i//C -CaC ' '� s t- t // eQ A l o '$ 1.�✓y !/ Ag1c`E- <br /> (,.ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: `2 6), 6 C9 <br /> NUMBER OF DEVICES (if low oltage):—/ A a r 3 } / <br /> Gtic[ 7 � ' <br /> FIRE ALARM? ❑ YES ..12K- <br /> ASSOCIATED <br /> .12 <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: {Q, 4 <br /> TA/5+44 /i /J/if K w �Al-ev'a 'I .0 ,^ /) P. p let LJ/ 9 <br /> r 1 t(, l / G`0 A A.N `� % `( di /7 a LA, <br /> Al L4_) -2-0 �Pi lu I , f C i ,^ � C) ( f E� 15 71 /A/!l <br /> 1�(f D, 5/ - U / Fci f. <br /> CONTACT INFORMATION 1 <br /> OWNER NAME: i3 ` �,t�Attie&51 ei^ t;--vq61-ANT IANT NAME(If Commercial : B4af /4/ �r�<i i�%L�l/c-Z <br /> OWNER MAILING ADDRESS: /STREET Z 2_ 3 S Lit Fl h5 V <br /> e'ff CITY `_L STATE 9k 9 Z 1 ZIP <br /> OWNER PHONE: 51-2...5---33g—3t)ot7 OWNER EMAIL: .1) �hc(N t; Alt4i, <br /> CONTRACTOR NAME: Fa r"ak <br /> CONTRACTOR ADDRESS: STREET `2,02.0 >Act I f b y , ( 0 -1_- 7 <br /> T''e' 1 �1 i( CITY 1,t1 ct STATE 9S�o Z ' ZIP <br /> J/ <br /> CONTRACTOR PHONE: ?tv C-Ci�,e' 1 S y% CONTRACTOR EMAIL: —k ��� 6E)- i'A.t' Loi/T - <br /> CONTRACTOR LIC.#(REQUIRED): FA R>,4' C%p <o/ 13 j_. CITY OF EVERETT BUSINESS LIC.#(REQUIR /V��+ <br /> '35 c,r, <br /> PRIMARY CONTACT: ElOWNER :El CONTRACTOR ElOTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 C2(L Z�y s----- 9s- <br /> CONTACT <br /> f s- , <br /> CONTACT EMAIL: �^ I:n✓.1 C�� Kt�'%Vi 1 r-j 'I C' <br /> AGREEMENT:I hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> • G73/1/ E MO(0 - <br /> wne Authorized Agent Signature Date (Revised 9/23/2016) <br />