Laserfiche WebLink
OLT ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I(E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��� �ai Y ( 5'4- <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED D SFR-ATTACHED D DUPLEX D MULTI-FAMILY-#OF UNITS: I,ZCOMMERCIAL <br /> USE OF BUILDING: • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 306,c <br /> NUMBER OF DEVICES(if low voltage): • <br /> FIRE ALARM? D YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#Of applicable): ���� <br /> DESCRIPTION OF WORK: V(SdoN'V��� f-l4=0� _ <br /> ,---4 SC <br /> CONTACT INFORMATION - <br /> OWNER NAME: (tZjc4,- LLQ 041 1-1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 4C-Z5' G//d(fy 5 264' <br /> CITY l=t4-7ZC.'2I'T / STATE , - ZIP cte c� <br /> OWNER PHONEttZtd Z52- ,6''//u 7 OWNER EMAIL: <br /> CONTRACTOR NAME: l:.V c1'o4-jiC 1.4 exr (t <br /> ' Ac <br /> ✓/ <br /> CONTRACTOR ADDRESS: STREET Cr20 req(,t C., <br /> CITY ajeg-a STATE (jJ>4 ZIP 9(- <br /> CONTRACTOR PHONE(clZ ) 2S`Z- 3 f t CONTRACTOR EMAIL: /' 4? ,5 S t(-JC .ac-7.44_ <br /> CONTRACTOR LIC.#(REQUIRED): •/�� ',5rj'1 Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED): `7cM' <br /> PRIMARY CONTACT: D OWNER Er CONTRACTOR 9 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 147_ ,- ZS Z_?//t f <br /> ��(v ..-CA CONTACT EMAIL: �,�, d1'55iv Luca .GY6/1"( <br /> 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 <br /> 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> i <br /> /z f, - / EMZ,_ 6 2 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />