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L CTRICAL PERMIT A&PLICATION <br /> CITY OF EVERETT PERMIT NVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 7 I Z a Ek-F1RQ_V'--Qg IV M <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 11SFR-ATTACHEDEI DUPLEX ElMULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: D.F.5-TA u P-A4,) <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 04410 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): p t' <br /> DESCRIPTION OF WORK: i m s'MA (v2 J� ��p � {� C VC u 1 -F <br /> L Ll -20 c " 7- C L kE <br /> CONTACT INFORMATION <br /> OWNER NAME: IM TENANT NAME(If Commercial): Y"��.- N/�� <br /> OWNER MAILING ADDRESS: STREET ' 9-o ��j- Fz L.")•X (� <br /> CIN STATE 8✓�/✓ / ZIP <br /> OWNER PHONE: >— 6 OWNER EMAIL: <br /> CONTRACTOR NAME: PO N TQ P_ C 7�kl C ,j C <br /> CONTRACTOR ADDRESS: STREET I 3 k C -TO 1 , O D <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: Uo-7,97- (3 O-o CONTRACTOR EMAIL: (n� <br /> CONTRACTOR LIC.#(REQUIRED): P <br /> 'D CITY OF EVERETT BUSINESS LIC.#(REQUIRED),C� <br /> PRIMARY CONTACT: ❑ OWNER 0,16ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: <br /> C <br /> CONTACT PHONE: ' (J <br /> �^ CONTACT EMAIL: <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/ <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 /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />