Laserfiche WebLink
"1144 ,---sa <br /> ELECTRICAL PERMIT APPLICATION <br /> ~ ORIGIN//��'� CITY OF EVERETT PERMIT SERVICES <br /> rC�200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> �} l `, --j(PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Rol l 41 71j.) <br /> BUILDING AREA(if residential, new construction, remodel,or addition) r 6 ow t 0 1 SF <br /> BUILDING TYPE:t'SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> �, <br /> CONTRACT PRICE OF WORK: $ (�( Jn <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> kk(I(DESCRIPTION OF WORK: r,l(CL)k -Priti AC I Y5 / <br /> CONTACT INFORMATION <br /> OWNER NAME: ' L1* ' IPJJ (-1(hh`l n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 81,\ 1 t" f S1.,{) (//, / <br /> CITY E:vor--et STATE CA ZIP l(�/7UWv' <br /> OWNER PHONE:"IZ �5i/— �5X J L ✓OWNER EMAIL: I �y,C�r(bt)�Y)���� (0Ai16 ID• Mr)71 <br /> CONTRACTOR NAME:13 \ug, Flom-e, <br /> CONTRACTOR ADDRESS: STREET 1\1 c),/�-1}'��Ij tv V <br /> ( 3-)- , $(� y 1 / /)/��JJCITY11)10 I V V� T�t r( re_ f, STATE ZIP IV 4 , <br /> CONTRACTOR PHONE: id Z,.-) !'i I ---14` l v l CONTRACTOR EMAIL: I n 4 b (fePIa (dryi - t-(-7,- <br /> CONTRACTOR LIC.#(REQUIRED):5 Lu-FH-S, ( l CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(k) /7, a 0 <br /> PRIMARY CONTACT: 0 OWNER -CONTRACTOR 0 OTHER (Please Specify) <br /> CONTA T NAME: <br /> / In /` CONTACT PHONE: KZ _ I — 7///�� �L <br /> I d A l/ I ( ,1-e0�(���'/�'Q.. CONTACT EMAIL: )0 fo �_l7/(G/�Y�r072. Z%t' l (2(3• --7-7 <br /> AGREEMENT:T hereby certify that I have ree and exarrl hed this application and know the same to be' truetrand correct. All 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 I am 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 /> A A A ' ------ /Zia/ Ile iis ) e E imoo(-oe� <br /> Owner/Air/Tan <br /> _r/Air/Tan Agent Signature Tlate (Revised 10/12/2015) <br />