2105 GRAND AVE 2017-06-02 - Laserfiche WebLink

GTRIC AL PERMIT Ad&ICATON CITY OF EVERETT PERMIT MVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits ROJE-GT SI'i� 9NFOR1Y1�1T1®><d PROJECT ADDRESS: J r✓' L- �� BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE:.®SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL [USEF BUILDING: ELECTRIG L A000bA" ION IN�ORI�i�Tl®I� CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: i CONTACT:LMFORMATION OWNER NAME: �( TENANT NAME(If Commercial): OWNER MAILING ADD SS: STREET Z O S -,Le CITYVA- STATE ZIP Q Z O f OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: A W CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: N OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: `` CONTACT PHONE: tZ -7- CONTACT -CONTACT EMAIL: a p , 0 VH AGREEMENT. T hereby certify t at I have read and examined this application and know the same to b4tr&dand 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 lawregulating construction orthe 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 #?too ,6✓ PERMIT# Owner/ tiorized Agent Signature Date (Revised 90/92/2095)