Laserfiche WebLink
/4Py%z--,A CTRICAL PERMIT AP CATION <br /> '041* _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3s S , U . 152-0,1 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ID SFR-DETACHED 0 SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> LIGATION INFORMATION <br /> CONTRACT PRICE WORK: $ SO�j,(fit <br /> NUMBER OF DEVICE <br /> FIRE ALARM? 0 YES CI,NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Folz ars OA-MR T4,--)IL <br /> �n CONTACT INFORMATION <br /> OWNER NAME: OA I ► t J\�L.L&A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3S t s— t' O't?rot-) 4%E p <br /> CITY STATE LA ZIP p ZC,1 <br /> OWNER PHONE:C`17s) 230A - `'I l 3iJ OWNER EMAIL: <br /> CONTRACTOR NAME: V14.1---)p6l=eb(._ €L ?Mc_ <br /> CONTRACTOR ADDRESS: STREET 123 6� �A � E1z <br /> CITY U-r0 t3 STATE ,y,)C4. ZIP WsZ.'31 <br /> CONTRACTOR PHONE: 3C:,(.).,) ~ 6 121._ CONTRACTOR EMAIL: -7-1. (-•E V-VADEP-etkL'GMA•XL • <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQ RED):n r"c19 3L. <br /> PRIMARY CONTACT: 'OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:I hereby 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 <br /> 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 <br /> local law regulating construction or the performance of construction. That!am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E U Co <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />