610 51ST ST SW 2019-09-10 - Laserfiche WebLink

• &LCCCTRIIC x,L PE- IT APOUCATIION r 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 I www.everettwa.govlpermits .; . P1" ,eJ CT SITE INFO 'MOM :-`:: : . ':.'.. .. ... _ . PROJECT ADDRESS: toll) ' ' 1 ."2-F9Yee.V SW CVC "r&I 1)/"3,4` 6.22D-3 BUILDING AREA(if residential,new construction,remodel,or addition) )S SF BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: YL' ►U.Qi(1T1(— ELECTRICAL APP1=.ICA°1701e1 INFORMAT10:4 CONTRACT PRICE OF WORK:$ I.GO NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): • DESCRIPTION OF WORK: OU- 4?- CAA. C,UU-A -kb AtOV CJG4CA ejlf CAAAS . " : - ' . --'1 " •: ::. COIV'TA ... CT itsiOotoilikticiNi. :. OWNER NAME: o f ta 0.001.Avie. TENANT NAME. (If Commercial): OWNER MAILING ADDRESS: STREET 1010.-S 1 " J W VIA /� v1}� cn Evei C/1 14rOg STATE I A ZIP l v�- OWNER PHONE: (101p-01161-1/123171 OWNER EMAIL: CONTRACTOR NAME: 01ANI.-K CONTRACTOR ADDRESS: STREET • CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: ' CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT:T hereby certify that 1 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 FEE --7 7 ----a • . _ PERMIT# ate, --•ifia, /-u) ( 3'O — 207 er/Authorized Agent Signature Date (Revised 90/9212015)