1424 MADRONA AVE 2019-02-11 - Laserfiche WebLink

• -LECT IIC Al PERMIT ALICATgON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov j www.everettwa.gov/permits • PROJECT ADDRESS: 14,0A (Y)�tw Af L ell IviA 'go 3 BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED elSFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION *CONTRACT PRICE OF WORK:$ If C900 NUMBER OF DEVICES(if low voltage): / FIRE ALARM? 0 YES ;2(NO ASSOCIATED BUILDING PERMIT#(if applicable): • DESCRIPTION OF WORK: onA.\ cl/la Yly OWNER NAME: �r.,71 51)'l oS TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET I 1- Lf Matil-pvIA ,4 , 1,1)--5 crrf STATE (��f zip C?3 OWNER PHONE: . 4 C 2 3 !, OWNER EMAIL: CONTRACTOR NAME: aerkf Z.-- CONTRACTOR ADDRESS: STREET ) L(0.5 (JI`i Sl- aw Cv-e.4 66- STATE w - ZIP l eJ 3 CONTRACTOR PHONE: ;/163'•122-I CONTRACTOR-yEMAIL: l/I/^ilAd3 e iy,t�keig (' C, _ID •?— CONTRACTOR LIC.#(REQUIRED) �ZpG�r4°c,Lµ3 Y)1 ( CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0.1/14:d PRIMARY CONTACT:Y�❑OWNER .M,� r ONTRACTOR 0 OTHER(Please Specify) "" " CONTACT NAME: CONTACT PHONE: )40c '1't 6 q 22 t CONTACT EMAIL: AGREEMENT.-T 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 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 1 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 00 402 1,6D , PERMIT# irf 0 Au orized Agent Signature ate (Revised 10/12/2015)