5106 23RD AVE W 2019-06-12 - Laserfiche WebLink

. . ojerr ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES N----) 3200 CEDAR STREET, EVERETT, WA 98201 ORIGINAL (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits ��-}} PROJECT, SITE INFORMATION PROJECT ADDRESS: J1(/Gj ,.5f7--,1 / ie (i / BUILDING AREA(if residential, new construction, remodel,or addition) r-6/( 0.0 I SF BUILDING TYPE: ,I"SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: Go,lr y heat- p-4--rip �p CnSYQLQ CONTACT INFORMATION l OWNER NAME:C y -6 �1U.+ , TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 60 ,3 five tel/ CITY 'ea l-- STATE l/r,4 ZIP q Lx/ ) OWNER PHONE: -LM-e'e46-1-5 OWNER EMAIL: -- �J CONTRACTOR NAME: [311,(e 11,(e I'i&irie CONTRACTOR ADDRESS: STREET//'' ll rn 27H 1 n/j(A) #, qm'yCITY �'1/ / I2Vef/ /A(� STATE ZIP CONTRACTOR PHONE: 7J7 71( - l3' t (CONTRACTOR EMAIL: - YC CONTRACTOR LIC.#(REQUIRED): -�jbOE CITY OF EVERETT BUSINESS LIC.#(REQUIRED0577/D PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER (Please Specify) CONT T NAME: In CONTACT PHONE: L - �'7 I - 7I5q I�VI�nI IVO) l / CONTACT EMAIL:i 0 'L/ gl ( ±-, AGREEMENT. T hereby certify that I have read"and mined 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 sp cified her in 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 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 FEE )4 1 "-"- 01)- _, 6 PERMIT# ( / / / z --- i9/7//91 E It,t6L-k— N \ Owner . :L.,:.,:4•U t-Signat - Date (Revised 10/12/2015)