11 77TH ST SE 2019-08-14 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 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 www.everettwa.gov/permits PROJECTSITE INFORMATION PROJECT ADDRESS: /i' 7* j BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: **SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING`: ELECTRICAL`"APPLIdA"TIO,N1NFORMA BION CONTRACT PRICE OF WORK: $ L? .00 NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES AENO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION.O.F...WORK:_ ..........._ Rep laC ./ "t-,► S lel r "_1 t ,CONtACT INFORMATION OWNER NAME: LOIMi JC.trct0 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET JU +1-2111 T �- Q '}/� i..d STATE 1v`I to, ei U 20 5� OWNER PHONE:4 Z(jE Z7'9'I TOWNER EMAIL: CONTRACTOR NAME: 1 e CONTRACTOR ADDRESS: STREET R-{15" Wo CITY i/7 R STATE \J ZIP 93 20(.. CONTRACTOR PHONE: I 3501 0 b CONTRACTOR EMAIL: jI CONTRACTZff LTG:""#(TtEQUIREb): he-401 rici CITY OF EVERETT BUSINESS LIC.#(REQUIRED fi(QC PRIMARY CONTACT: 0 OWNER ,CONTRACTOR 0 OTHER(Please Specify) ) CONTACT NAME: �� CONTACT PHONE: LIQ6 590 550 I P,al a ie CONTACT EMAIL: do ' titan (O(' ) AGREEMENT:I hereby certify that I have read and examined this application end know the same to be true end 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 1 em 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 PERMIT# � E 1Q)O027 Owner/Authorized Agent Signature Dale (Revised 9/23/2016)