1129 MAPLE ST 2017-06-21 - Laserfiche WebLink

CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE [INFORMATION PROJECT ADDRESS: t euewe-L( BUILDING AREA(if residential, new constrruc/ion, remodel, or addition) SF BUILDING TYPE: ❑SFR-DETACHED M SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLIC ATIO'N INFORMA -IOM CONTRACT PRICE OF WORK: $ 7VC NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES XNO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CONTACT 1NFORMATION OWNER NAME: ( S /\jI -T ANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET jel r CITY STATE ZIP OWNER PHONE: — gI OWNER EMAIL: CONTRACTOR NAME: OWN 157 CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRE ): PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: — V ILL CONTACT EMAIL: AGREEMENT:Thereby certify that/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 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 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE PFIRMIT# _C41 16 1 Owner/Aut r ed Age Signature Date (Devised 10/1212015)