Laserfiche WebLink
LE CTR CAL PERIVIDT APPLICATION <br /> rCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PisOJ CT SITE INIFORMATIMI <br /> PROJECT ADDRESS: 33 f &T M©rQL 1J E\J RE TT cj -6201 ( <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 23-10 SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED ''I'DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: 2ES 1P-KF 1 L <br /> ELECTRICAL APPL!CA TII DNFO rG ATO®1 <br /> CONTRACT PRICE OF WORK:$ 7 COO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES NJ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C. no 3- 0 <br /> DESCRIPTION OF WORK: kpj tki kV_ tab I - t\ G4 Ti tit- {��1 L i 5t'vD ; 0 611?(.. i24 <br /> e P"TU uk)v-v5 <br /> CONTACT INFORMATION <br /> OWNER NAME: }���� R \ e TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,Qa r 2„{v�,Q s+. y <br /> Kw( kA-14i h.N, cm, STATE ZIP 603- <br /> OWNER PHONE: Z.04. 221 Q( 61jL OWNER EMAIL: C)�71J T GINYttrt Lis �`C'M•.� <br /> CONTRACTOR NAME: 02T{4 _E C c s-e-Ru i <br /> CONTRA�CT�OR`ryADDRESS: STREEk 4Q 14 L.p�U-} WA�`�/ <br /> Ilv)006 Ob Cm? STATE vjA ZIP et-8061- <br /> CONTRACTOR PHONE: 2._012 7-78, ct ©5fCONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): N OEZT1-{s S B b 1 LL CITY OF EVERETT BUSINESS UIRED): ) <br /> PRIMARY CONTACT: `ala OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 6 <br /> Z2-7 16 s4 <br /> M k5VG< / CONTACT EMAIL: / i vT 6,2441M .V1,., <br /> AGREEMENT.*T 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 <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 lam authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> • <br /> MIL <br /> PERMIT# <br /> t0k /� E 02. 0 <br /> Owne orized Agent Signatur- ate (Revised 10/12/2015) <br /> LGt rrlei&GTow <br />