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FifCTRICAL PERMIT APICATION <br /> CITY OF EVERETT PERMIT SE ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1-11-30 �;` p,ti �,� O 1 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 1(&L SF <br /> BUILDING TYPE: ❑SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: `- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1 55—al u <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO f <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: vv1A. A \ f i <br /> CONTACT INFORMATION <br /> OWNER NAME: Q `j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: LV26) �)-?S 0 f C,.�� OWNER EMAIL: <br /> CONTRACTOR NAME: SQ-c Florae- C(ec-{r i t <br /> CONTRACTOR ADDRESS: STREET /-�81110 I" 'C <br /> CITY LG,Ee�ri0� STATE L�7`1 ZIP �" 7 <br /> CONTRACTOR PHONE: X53 iO CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): S 4i-C N(!E CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER OCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 22 - ��bCy<9 <br /> CONTACT EMAIL: �/�f-�f`��`'/u L GCC_1?'��� <br /> AGREEMENT:Thereby 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Oficial Use Only <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature - ate (Revised 10/12/2015) <br />