2026 RUCKER AVE 2017-06-29 - Laserfiche WebLink

��i�� s� ��i�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJEC7' SITE INFORM/�'�'ION PROJECT ADDRESS: � � `r . 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: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: � r- CONTACT INFORMATION WNER NAME: /`,� /t ��----- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srReer � •; �Z__ � ,�I � CI i( STATE � ZIP Z VL�� OWNER PHONE: — Z Z- �.1 Z--- OWNER EMAIL: CONTRACTOR NAME: L`� l-U� -G�---, CONTRACTOR ADDRESS: sTREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL CONTRACTOR LIC.#(R�QUIRED): CITY OF EVERETT BUSWESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT.�T hereby cerfify that I have read and examined this application and know the same to be true and correct. AlI provisions of/aws and ordinances governing this type of work will be completed whetlier specified herein or not. The granting of a permif does not p�esume to give authority to violate or cancel the provisions of any othersfate or local law�egulating construction or the performance of construction. That I am authorized by tl�e owne�of this property to perform the work for which application is made and 1 comply with the Sfate Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only �Ml ��..J� ;7 r, c� FEE ` � � r�� i` , �.,+.•.. � � ��iU a.��- , PERMIT# � � j ,z � �}r'�;��R�r� � b - 2� Ow e �uthorized Agent Signature Date �� (Revised 1 D/12/2015) �^�( f��(� f' .