12528 22ND AVE SE 2016-09-14 - Laserfiche WebLink

ITEC TRICAL PERMIT *PLICATION CITY OF EVERETT PERMIT J�v]CES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 (E) everefteps@everettwa.gov] WWW.everettwagov1permits ........... 7 7 PROJECT ADDRESS: I'L20e BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 11 SFR-DETACHED 11 SFR-ATTACHED El DUPLEX EI MULTI-FAMILY-#OF UNITS: El COMMERCIAL USE OF BUILDING: -CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (if low voltage). FIRE ALARM? 0 YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: t", O~ TI .,7 O TACT-MIF RIIILA 0 OWNEP,NAM&jL--_'- TENANT NAME(if Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE, OWNER EMAIL- CONTRACTOR NAME: �Vv/rll/ CONTRACTOR ADDRESS: STREET 41�7 STATE Zip CONTRACTOR PHONE: 1CONTRACTOR EMAIL: CONTRACTOR LIC..#(REQUIRED). 'f ed el- 9y1" CITY OF EVERETT BUSINESS LIG.#(REQUIRED):oro lO PRIMARY CONTACT: 11 OWNER ACONTRACTOR 0 OTHER(Please Specify) CONTACT NAMY: CONTACT PHONE: ev CONTACT EMAIL: 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 type of work will be completed whether specified herein ornot. 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 18.27RCWand296.200 WAC- Cify of Everett Official Use Only FEE 010 PERMIT# E d va I Eo'�_77_ OwnerlAutliorized Agent'Signature Date (Revised 1011212015)