Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br /> viiii <br /> -,-- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov i www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: !2 / ( f", /I,L„ l &4t. vlluj— Dr, <br /> BUILDING AREA(if residential,-new construction,remodel, or addition) SF j100 <br /> • <br /> BUILDING TYPE: $SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: r) 1.z it <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 50, °' / pm 4_ 2,-I t 1 r <br /> NUMBER OF DEVICES(if low voltage):, <br /> FIRE ALARM? 'DYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): E(,33 18-O '-' 0 03 ch / (V f I) �, ^ 0 0/ <br /> DESCRIPTION OF WORK: 7 �V AFC- / .. r�ker,s y/"4", ,/(Al,.�) <br /> f.u/ h r o oris cI cl ," e-c,l� - c04_^0.-P)S--or-( SiltK A ei `.�5n fi� k` / Ck <br /> cI fay dif..1.04ch.— . <br /> E / --r s�c I pe< c f t re-2 ark � � © (y a�4 (: <br /> U l" r `'<-2 t1 c.-V fl" c.v- V14 r 74f O�74-s 04 H <br /> CONTACT INFORMATION <br /> OWNER NAME: GQG-(S /L2 Ay TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET tC f (� /( , /�'��, r n e Cf r 0 , <br /> F--,/.-4 CITY GO 4 STATE 8-,2 0/ ZIP <br /> OWNER PHONE: 4,.. °L - 7 SS - g7, 7, OWNER EMAiL: 5'rc TA©yu .9._/, Q.,i. 9 7,k 4o (--'2-1-z-/ <br /> CONTRACTOR NAME: V u....ii 2.,r- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> ,��,:,...... s.: <br /> �w .._.. <br /> PRIMARY CONTACT: 'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that l have read and examined this application and know the same to be true and correct. Ail provisions of laws and ordinances governing this <br /> 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 <br /> local law regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Liami / L - , V/ CV/ 5 E cit. 06,—CLQ Q <br /> Owner/Authorized Agent Signatu,/ Date (Rev. 1-10/12/20152 <br /> c <br /> t Orli <br /> d P'-- mak <br />