7515 BROADWAY 2017-06-09 - Laserfiche WebLink

�-:LECTRgCAL PER LIGATION OL CITY OF EVERETT PERMIT VICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 ] (E) everetteps@everettwa.gov( www.evereftwa.gov/permits EBUILDING ADDRESS: f�/� ,r o v✓ AREA(if residential,new construction,remodel,or addition) SF TYPE: ❑SFR-DETACHED Q SFR/ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS. I] COMMERCIAL UILDING: CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: -� /"6�.•�r✓ !Po% fTENA'- _COI±IT;ACT�INFOR1ViA,'fION-� _ _ GiiNNER NAME:+ ,,� .C��'7 �i✓ d� NT NAME(if Commercial): OWNER MAILING ADDRESS: STREET CITY STATE 7JP OWNER PHONE:-,. .OWNER EMAIL: CONTRACTOR NAME: rr A;1 ez CONTRACTOR ADDRESS: STREET CITY rll'f 7 D h STATE 7 ZIP 9� CONTRACTOR PHONE: CONTRACTOR EMAIL: • CONTRACTOR LIC.#(REQUIRED): _7_�l�. i v 7 FYI�L CITY OF EVERETT BUSINESS LIC.#(REQUIRED); PRIMARY CONTACT: Cl OWNER jfl CONTRACTOR El OTHER(Please Specify) CONTACT NAME:lty � CONTACT PHONE: [�/? 3� O 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 ornot. The granting of a permit does not presume to give authority to violate or cancel the provisions of any otherstate or local law regulating construction orthe performance of construction. That l am authorized by the owner of this property to perform the work forwhich 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 5 oC) l PERMIT# E 1 &04- Ovvner/Authorized Agent Signature Date (Revised 90/12/2095)