814 109TH ST SE 2017-06-07 - Laserfiche WebLink

' 09/06/2016 TUE 9: 06 FAX 425 252 1666 CM Heating 0003/004 ACTRICAL PERMIT AF�-L.ICATION CITI' OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov www.evorettwa.gov/perrnits PROJECT ADDRESS; 81— ie, BUILDING AREA(If rosldentlal,new construction, rernodel, or addiflon) $F BUILDING TYPE; ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: '�•��.'{1naqq�,'�A I""�titJ Tk�y�xl,lJt1J'.JpA "fi , 3 �G , ,, s CONTRACT PRICE OF WORK; $ NUMBER OF DEVICES if low voltage).- FIRE olts eFIRE ALARM? ❑ YES Q NO ASSOCIATED BUILDING PERMIT 0 If applicable): DESCRIPTION OF WORK; OWNER NAME: TENANT NAME If Commergial ; OWNER MAILING ADDRESS: srRt \A // CITY V STATE �/ p rip OWNER PHONE; OWNER EMAIL., CONTRACTOR NAME: CONTRACTOR ADDRESS: STREF-T CITM STATE zip . CONTRACTOR PHONE; 0 � `,CONTRACTOR EMAIL; CONTRACTOR LIC,#REQUIRED : Y>, CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Q PRIMARY CONTACT; Q OWNER CONTRACTOR 11OTHER(Please Specify) CONTACT NAME; CONTACT PHONE: H22 CONTACT EMAIL; t` AGREEMENT:T hereby carilfj that l heva read and examined this application and know the same to be true and correct. All provisions of laws and ord rtes governing this typo of work will be completed whether speciRed hereln or not. The granting of a parm/t doa9 not prestima to give authorlty to violate or caecal the provisions of any other stete or local law regulefing construction or fie performanoe of conatrvotlon. That I am authorized by(he owner of this pmpeny to perform the work for which oppilcailon Is mads and 1 comply with the Stale Contractors Lew 18.27 RCW and 2P6200 WAC. City of Everett Cfflclal Use only FEE t PERMIT#t Ownor/Aulhorized Agent Signature Date (Revised 90/12/2016)