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Ojerr !..ECTRICAL PERMIT APtICATION <br /> 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: 24,3.,Z Ci d 1-,e V ye- W A 9`32 0 ') <br /> BUILDING AREA(if residential, new construction, remodel,or addition) G? SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED D DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES JNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: genlo(a�o <br /> tri I l n-I-b I w i 0 0 0-4-1 c.4 <br /> CONTACT INFORMATION <br /> OWNER NAME: I-101 V P€.+2(,s to TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 Lp2Z 1 �J J <br /> CITY p 1 wkl Y ,� STATE A t ZIP tS (5 <br /> OWNER PHONE: ( 20(x) ) t 1010 OWNER EMAIL: holy f>z_71- .r`5.en 0. ObI�T-�0 0 k. �UT1 <br /> CONTRACTOR NAME: a`.�V�!t'le,/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (ZoL) ) 330 — j b I 0 <br /> 1-1 011 \/ e+. e rS CONTACT EMAIL: <br /> !J `P �1 h��� r ��-�' ✓ 1 e 6:,4-1 o o k.C p{'Yl <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 I 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 /> zi <br /> Owne01) <br /> rized A ent Signature Date (Revised 9/23/2016) <br />