1228 GRAND AVE 2022-02-08 - Laserfiche WebLink

PLECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: BUILDING AREA (if residential, new construction, remodel, or addition) !� SF BUILDING TYPE: E]SFR-DETACHED E9 5FR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: ❑ 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: CONTACT INFORMATION OWNER NAME: .¢. lr3 rc �%`tl�� j�O TENANT NAME (If Commercial): OWNER MAILING ADDRESS: STREET �crscQ CITY !^� ..�+ �,� STATE LfZIP 2 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: pT Zf L C7 CONTRACTOR ADDRESS: STREET G S CITY Aclllei &" STATE ZIP CONTRACTOR PHONE: ,570 3X6-,C CONTRACTOR EMAIL: CJS ec� w CONTRACTOR LIC. #(REQUIRED):0 4�),2,,Z gCITY OF EVERETT BUSINESS LIC. #(REQUIRED):,�0,2�.S J PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT,/ hereby certify that I have read and examined this application and know the same to be true and correct. Ali 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/ 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. Owner/Authorized A4K Signature Date City of Everett Official Use Only PERMIT # E 11 (AW� (Revised 912312016)