2105 GRAND AVE 2017-08-18 - Laserfiche WebLink

CITY OF EVERETT PERMIT VICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 ] FAX 425-257-8857 ] (E) everetteps@everettwa.gov] www.everettwa.gov/permits PROJECT SITE ONFOIZiVi�iTl®ltd PROJECT ADDRESS: 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: ELECTRI��rIL APPL9CA"1"9®N INFORMA.'�IO CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: = CONTACT:LMFORMATION OWNER NAME �( TENANT NAME(If Commercial): OWNER MAILING ADD ESS: STREET 2/05 CITY STATE MP OWNER PHONE: 1 OWNER EMAIL: CONTRACTOR NAME: v`/U CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED)' CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: N OWNER v❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: I CONTACT PHONE: Z5 Z 7 7k'j' I �l Li WI CONTACT EMAIL: �� a A 0 p . C O I'm AGREEMENT. T hereby certify t at I have read and examined this application and know the same to b t and correct. All provisions of laws and ordinances goveming 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 U PERMIT## Owne1�orjzed Agent Signature Date (Revised 10/12/2015)