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02/25/2016 10: 39 4254897996 HOME RUN ELECTRIC PAGE 02/02 <br /> 0 0 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CrzOAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 FAX 425257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT ADDRESS <br /> BUILDING AREA(if residential, new constructfon, remodel, or addition) SF <br /> BUILDING TYPE! SFR-DETACHED EISFR-ATTACHED EIDUPLEX LJ MULTI-FAMILY-#OF UNITS: LJ COMMERCIAL <br /> IUSE OF BUILDING: <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low voltage): � <br /> FIRE ALARM? ED YES NO <br /> ASSOCIATED BUILDING PERMIT 9 (ifapplicable ! <br /> DESCRIPTION OF WORK: C.c <br /> .......... <br /> OWNER NAME: TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: ceaoC--� <br /> C17Y sk STATE 2-0 <br /> OWNER PHONE; OWNER EMAIL; <br /> CONT <br /> CONTRACTOR ADDRFSS: STREET <br /> r r7y STATE 71P <br /> CONTRACTOR PHONE: qc)15—�14-7C) 411CONTRACTOR EMAIL, <br /> CONTRACTOR REQUIRED): CITY or EVERETT BUSINESS LIC.#REQUIRED): <br /> PRIMARY CONTACT, 0 OWNER WTINTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME;7� CONTACT <br /> PHONE: <br /> MAIL;CONTACT E <br /> A GREEMEN7';T hereby oertify that)have read and examined this sppflpo(1r'nqnd know the samWo be true and correct. Ali pro vision a of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not The granting of aoerrnit does not presume to give authority to violate or cancel the provisions of any other veto or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this properly toperform the work foi,which application is mqde 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 /> PERM[T# <br /> 0 er/Auth:ri d Agent Signature Date <br /> (Revised 10/74,207a) <br />