501 VERALENE WAY SW 2019-07-09 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION /11111d-----a 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: 501 Veralene Way SW BUILDING AREA(if residential,new construction,remodel,or addition)200 SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: residential _ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 900.00 NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: Install charging connector for electric car CONTACT INFORMATION OWNER NAME:Steve TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 501 Veralane Way SW ciTv Everett STATE WA zip 98203 OWNER PHONE: 206 390 9687 OWNER EMAIL: CONTRACTOR NAME: k v electric corp CONTRACTOR ADDRESS: STREET p o box 382 „Ty Silvana STATE wa ZIP 98287 CONTRACTOR PHONE:425 503 4305 CONTRACTOR EMAIL: kvelectric@msn.com CONTRACTOR LIC.#(REQUIRED): kvelec*972CJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):052588 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206 390 9687 Steve CONTACT EMAIL: AGREEMENT*I hereby certify that/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 I 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 or .zvkb61 -•PERMIT # � � I Owner/Authorized Agent Signature D to (Revised 9/23/2016)