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rLECTR0C1, L PERMIT A�,.�� 1JCATION <br /> "'41W- <br /> y - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> • PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: O() C(fa.✓ 5T Z,tc-- C. t 60 if (:)(jWL I <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 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:$ 6� ij..6'0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 01(.003,01 <br /> DESCRIPTION OF WORK: A-4 2)Is 2-6rd4x L;,,46 t5-,Ai; / / t.52,-- 96,-7-6" Z�G A,47--- <br /> riert42c-$. /n/7 •77,16(2) crC�.g/2�9 ccice�. 41 ,( 0)77al - ZL'cr/etVL <br /> d v9t.e--7-3 . 4s O C() z :Sly -k&e 7 V4 'i 4 ,y °' A.14-4) . <br /> Adee fi eix) 17 D,20)/34 Dv o..Je(,) i /PX6Je- �2iA . Ad/ &ke(I) <br /> iJ�t 3 L;G ‘0' - f-,'xT F A/ A.1r2-41Z . ri'-e'04L.e, e ce-- $ ce-, <br /> CONTACT INFORMATION <br /> OWNER NAME: 6-71-TA/ <br /> D4 ie-+^e TENANT NAME(If Commercial): <br /> ✓ <br /> OWNER MAILING ADDRESS: srREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: eGalle Q <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> IJ' If Feel=er 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 orthe 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 /> FEE <br /> VI -017 <br /> PERMIT# <br /> thhet,- _7- /7741?/d F <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />