1006 109TH ST SE 2016-09-15 - Laserfiche WebLink

LECT R0CAL PERMI TLI CAT I® CITY OF EVERETT PERMIT cRVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 ] (E) everetteps@everettwa.gov] www.everettwa.gov/permits CT-SITE IA1OR1ViAT1®Itl PROJECT ADDRESS: L � X BMW BUILDING AREA(if residential, new construction, remodel, or addition) f "'i-e-lel ' a SF BUILDING TYPE: ❑ SFR-DETACHED )4SFR ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ' ELECTRICAL APPLICATI®N lir FORMATI:o PN . [NUMBER ONTRACT PRICE OF WORK:$ 'L J0"�(JJ OF DEVICES (if low voltage): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: c Jit • C �1 `� e- I k A rad CONTACT INFORMATION OWNER NAME:j �� (` i L� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET OC) 6 + yC) f 4- CITY �/ r—e / / STATE W ✓/ "P / OWNER PHONE: b F, - Z OWNER EMAIL: L 0 0". 1,0 G C'✓'7 CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CIN �i (' - STATE W'A�- ZIP ( G CONTRACTOR PHONE: f CONTRACTOR EMAIL: CONTRACTOR LIG#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER --ONTRACTOR ❑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 1 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 LDO °° PERMIT# lz-q /16 1 Owner/Authorized Agent Signature Date (Revised 1071212015)