1815 125TH PL SE 2019-08-20 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION - CITY OF EVERETT PERMIT SERVICES i 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov ( www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1 43(S IZ5` 1 PL- BUILDING LBUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: %SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ .coo NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES k/NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: +c-rilev potilkf CONTACT INFORMATION OWNER NAME: �.}thin i y .ytj-j TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET f � .-1( f�y��y erry ,~ � V)0 1 -1 C? 2— S STATE ZIP OWNER PHONE:42S 33-7 e). OWNER EMAIL: CONTRACTOR NAME: CPA N.-all 0 9 t �,,�} CONTRACTOR ADDRESS: STREET } Q }OJT 1pt1 5 ?J� Odt 1J /� �(� CiTl' C.•lieN�V'1 STATE \AJIA, 7.1P qt 20 1 CONTRACTOR PHONE: LOS' q 0 !CONTRACTOR EMAIL: d 601,21. c -Y1lleA4-419 r 2Q✓Yf CONTRACTOR LIC.#(REQUIRED):C, h tE-04(*gy-rIdr1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ILOCIS PRIMARY CONTACT: ❑OWNER pS,CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: I--- S 359 D -TDO & le CONTACT EMAIL: dib►' h.e, I .t.or, 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# 4 leAb _cutvb _ S. 1 to- 7 E - 222 Owner/Authorized Signature Date (Revised 9/23/2016)