2126 RUCKER AVE 2019-04-16 - Laserfiche WebLink

/11.4 11 ¶LECTRICAL PERMIT ASII'LICATlON 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 PROJECT SITE:INFORMATION PROJECT ADDRESS: Z )2L E 2 Av6 e.VE-e•E,t-i- , t-30 BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: t-I C)iN1� ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES CISNO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: G OI G Cle-on" Zcx' A-onP S 6evCC.6 `r 310 SERC CE CONTACT INFORMATION OWNER NAME: C.Pl-2_t_ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2 tZ G v.ctt c._. A VE. CITY V b6 TI' STATE L-311, ZIP OWNER PHONE: (IZS') i L( c1 - OWNER EMAIL: CONTRACTOR NAME: VA- E L.6 CTRTL CONTRACTOR ADDRESS: STREET 2S 6 if 2 q-r..za._ DIL CITY g I.AtZL-1^3G j O. STATE UR ZIP rUt3 CONTRACTOR PHONE:(. , 3 `6 - 6122 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): VVfA-4D Q5"t 5DC CITY OF EVERETT BUSINESS LIC.#(REQUIRED):9`0 12- PRIMARY 2PRIMARY CONTACT: 0 OWNER *CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: f CONTACT PHONE: Cz �� > G tat_ CONTACT EMAIL: AGREEMENT:!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 PERMIT# (2--37(7 E OS—f '- Owner/Authorized Agent Signature Date (Revised 9/23/2016)