1924 MCDOUGALL AVE 2019-02-20 - Laserfiche WebLink

'llI I ill I 111* ,,,,m/n;-1 D T ET �- 3200CITY CEODAR EVERETT STREET, EVERETTPERIT , WSERVICESA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov l www.everettwa.gov/permits PROJECT SITE INFORMATION",• PROJECT ADDRESS: i l a /L/( t) 0 U 5 r /J ilk, c- , 6v e R LT I- (v/P J. -i'a D ( BUILDING AREA(if residential,new construction,remodel, or addition) SF aon BUILDING TYPE: / SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL i USE OF BUILDIN(: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 3 5'0,� ,o NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PE IT#(if applicable): J 14/4 ( '/ / / ,t1:2:57>___ DESCRIPTION OF WORK: (, 7`' G (I ! ` W4( D wt 745 g I(' ((i_.-E 5 1 y 04Q"GLt W LIn` c -L.n c c . GI CONTACT INFORMATION . • OWNER NAME: V Of E KS ,j av p R TENANT NAME(If Commercial): OWNER V, MAILINGADDRESS: STREET g3 ,a 0 . 1011 y OP # E?F'1T CRY STATE �Y/ P- ZIP 2 ga,O L( OWNER PHONE: L( p`t .5� 07 3 Lf 9 q O OWNER EMAIL: olt f PJ ?/) ' , c fin / /'f • C a Jr) CONTRACTOR NAME: (5 LLJ k)- g . CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT:w 0 OWNER M rs❑CONTRACTOR 0 OTHER(Please Specify) • CONTACT NAME: CONTACT PHONE: 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 t 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 / . PERMIT no Agent4 , 03 , 0 g , re. E 3 -co3 Signature Date (Revised caner/Authorized g10/12/2015)