10115 23RD AVE W 2017-01-13 - Laserfiche WebLink

�_��.� ��Q� ��. �� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 j (E) everetteps@everettwa.gov � www.everettwa.gov/permits PliO�EC'T S17'E INFORt�IdQ►7'IOR! _ _ _ _. . _ PROJECT ADDRESS: ��' �� Z� �j �� f 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: ' lU'� �� ELECTRICAL �1PPLICATION IMFORMATION CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (if low voltage): FIRE ALARM? YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: � � `� � � ., �I��J _ _ CONTACT INFORMATION OWNER NAME: ��,'(�Q�j �,�-��C_ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srReEr `� � CITY STATE ZIP OWNER PHONE: �12� � � C� �L OWNER EMAIL: �' V��'�j.��-,��I`L �9I'��I L Ld�� CONTRACTOR NAME: CONTRACTOR ADDRESS: srReeT CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL• CONTRACTOR UC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) C�N7ACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT.�T he�eby certify that I have read and examined this appiication and know the same to be true and correct. All provisions of laws and ordinances goveming this fype of work will be completed whether specified herein ornot. The granfing of a permit does not presume to give aufhority fo violate or cance/the provisions of any other state or local lav✓regulating consfruction or the performance of construcfion. That l am authorized by the owner of this properfy to perform fhe work for which application is made and l comply with the State Cont�acto�s Law 18.27 RCW and 296.200 WAC. City of Everetf Otficial Use On/y FEE � '^� ��r V PERMIT# � Z . \ � � � �� Owne orized Agent Signature Date (Revised 10/12/2095)