10031 19TH PL W 2019-06-11 - Laserfiche WebLink

11LCCCTR CCAL PERMIT Al ll U CATIION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8890 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits R,LIIIECT SITE INFO MATRON PROJECT ADDRESS: 1- V � 9 F2_v �r�v 3I / � � lc1' ,� �7� Lc/ 51 BUILDING AREA(if residential,new construction,remodel, or addition) SF 50% S F BUILDING TYPE: ❑SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: ELECTRICAL APPUICATION INF•-RMATIia,N CONTRACT PRICE OF WORK:$ 04D NUMBER OF DEVICES(if low voltage):, I FIRE ALARM? 0 YES ki'IV0 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CONTACT;INFORMATION OWNER NAME: ( ' p 7 _ A_ b (,f ij TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET J Db?I /1 c ' J, ifs y `/r� 1 Y P t DD(-r crrY G v/l� '(-i STATE (lin n ZIP 1 22 0 OWNER PHONE: Q O 2ii-0 F24-45 OWNER EMAIL: TC- L 2 CONTRACTOR NAME: Ov CONTRACTOR ADDRESS: IJs�TREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: WNER ❑CONTRACTOR ❑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 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 296.20b WAC. City of Everett Official Use Only 11L--- g e 00 / _ PERMIT# / 1 40 /i7 Owner/Autho ed Agent Signature Date (Revised 10/12/2015)