3623 WETMORE AVE 2020-01-21 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 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: j3,,, W e511 1C re- BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: /QFRDETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL''APPLUCATIoN'INFORMATION CONTRACT PRICE OF WORK:$ 250 ,«> NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: IncinAAc ci-1 es lurid- CONTACT INFORMATION OWNER NAME: . t . .: . .- Tdxei 1'1G1 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET :7102,3 Wetmore_ fE- cnv ede .Yr l _ STATE 1,43 A- ZIRgL.0 I OWNER PHONE: 142,5 -"7G'I --zgos 'OWNER EMAIL: CONTRACTOR NAME: "t CONTRACTOR ADDRESS: STREET ( p Li rs Wo L,�y�Q, ` - ' ,may cny (e,ti eRe '"(,�+r';.w`1 STATE 1A/ ZIP.q5 20 1. CONTRACTOR PHONE: 11a5q b (CONTRACTOR EMAIL; de b e CJ C'/S�v� l 4-id- j , +) CONTRACTOR LIC.#(REQUIRED):CYY1i t2.(Wn i%— - CI JCITY OF EVERETT BUSINESS LIC,#(REQUIRED): I too PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 1--fQsa5aa Wale Ie CONTACT EMAIL: deb 3( ( aii ,corn AGREEMENT:I hereby certify that(have read and examined this application and know the same to be true and correct. All provisions of/avis 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!am authorized by the owner of this property to perform the work for which application is made and! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only P€12/24'_ PERMIT :City 5 10.25.! 7 E (0 - 2 c5 Owner/Authorized Agent Signature Date (Revised 9/23/2016)