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_ECTRICAL PERMIT A_=LIGATION <br /> 41577 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: /6'O7 HOYTAlit <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED PLSFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ (0/ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES INO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): A4I go3 -- ©e 2. <br /> DESCRIPTION OF WORK: 2jvg ,4-t A-nief.Al �q-S ,i ,e.-rt/f}O�l 4.7k),0 -M2e4.) <br /> 1-P017- W/4'orEa <br /> CONTACT INFORMATION <br /> 4IWNER NAME: sc....) Z-U.Pk TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1107 ge Ikke. <br /> CITY STATE (..444— ZIP <br /> OWNER PHONE 09e4--qe9 g— /0-2 OWNER EMAIL: <br /> CONTRACTOR NAME: DJM/ +-I./ E PLJ4 --�-lje0o- <br /> CONTRACTOR ADDRESS: STREET ,,/G /1.../ tz Mike /xi 2 <br /> CITY Ly/V A/�Q STATE WA— ZIP gb(/ry/).J 7 <br /> CONTRACTOR PHONE: 1-12.-5-175--‘,Li t CONTRACTOR EMAIL: 6'416440 paef.tf, rti,o vtrE,"ti-&-r <br /> CONTRACTOR LIC.#(REQUIRED) actrdspi--9tAlia CITY OF EVERETT BUSINESS LIC.#(REQUIRED):oictiq <br /> „._. <br /> PRIMARY CONTACT: 0 OWNER ALCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: II ZS -77 V41, <br /> ire-4644i CONTACT EMAIL: 80.A 4,,,, DA,teAvvi iV <br /> 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 <br /> 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 <br /> 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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> ' !/_ #5 //11 <br /> E (Z03--O2 <br /> Owner/Au o ized Agent Signature/ �� Date (Revised 10/12/2015) <br />