5902 LOMBARD AVE 2016-08-08 - Laserfiche WebLink

CITY OF EVERETT PERMIT � VICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits �'�iOJECT' S9TOl� y l_ PROJECT ADDRESS: rJ'IO L Lo vi u�� V2 I�tle BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPINFORMATION FCONTRACTPRICE OF WORK:$ DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: i J l t Z ` z;✓•` _ . CONTACT:INFORMATION OWNER NAME: L Cierg �ij �} TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr ` r CITY `r ^ STATE t l ZIP OWNER PHONE: 2 2`if 1.OWNER EMAIL: CONTRACTOR NAME: X o_ ( I Mt s'e ( l PiPi CONTRACTOR ADDRESS: STREET I CITY � \e. eJ�.�s STATEVIA ZIP 'L.s CONTRACTOR PHONE:' 2 JC1 06c,) CONTRACTOR EMAIL: Q P 0 0 CONTRACTOR LIC.#(REC2UIRED): t��c'-1 rj 2 CITY OF EVERETT BUSINESS LIC.#(REQUI A): PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT..Thereby 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 98.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE PERMIT# E �� bb - 00 Owner/Authorized Agent Signature Date (Revised 90/92/2095)