5403 13TH AVE W 2019-06-05 - 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 ADDRESS: t . PROJECT SIT.E:INFORMATION 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, ELECTRICAL=AP SLI ATION INFORMATION' CONTRACT PRICE OF WORK: $ 2_5-0 o0 NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: 1P1L W q4— CoNtAb IN ORMArioN OWNER NAME: nill ettA/24 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: StwFEt 3 /313/ G;7 I�/'� CfTY .�t..+`' STATE ZIP 2� OWNER PHONE: , ,, a' OWNER EMAIL: CONTRACTOR NAME: CrYl V Q- :41.09 CONTRACTOR ADDRESS: STREET 1 1.415 Woad tjQi ieer V1 STATE r ZIP Cqk2r,,[ CONTRACTOR PHONE "'IQ5C?f5-"► a%-Z> CONTRACTOR EMAIL: d€ b eill)-=r1( ,t)yl Y CONTRACTOR LIC.#(REQUIRED):Cril e-OJI 1V, 1" I din lCITY OF EVERETT BUSINESS LIC.#(REQUIRE D/)• /1QO 1 PRIMARY CONTACT: 0 OWNER ,,CONTRACTOR 0 OTHER(Please Specify) (` CONTACT NAME: Veid.ale CONTACT PHONE: LI3590 CONTACT EMAIL: deb , AGREEMENT:I 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 riot 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 I am 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# ppb ` c.. id, a ,t7 E k. c) OwneriAuthorized Agent Signature Date (Revised 9/23/2016)