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rf It <br /> LLECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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: ;Z—O y U Cl L✓rt v <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: GXCOMMERCIAL <br /> USE OF BUILDING: c,t ,IJ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3 IL7 O <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OWNER NAME: om TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �—� Y O Gt z <br /> CITY tt STATE ZIP <br /> OWNER PHONE: 2 � — �D OWNER EMAIL: �� o Nh .n 7e <br /> CONTRACTOR NAME: r- <br /> CONTRACTOR ADDRESS: STREET t /w ( 1 ,I n <br /> CITY n STATE yv ZIPO' <br /> CONTRACTOR PHONE: 6 -' CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): W-f 17Cw z- i0or CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER *ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 2 bvl CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I ha ve read and examined this application and know the same to be true and corr ct. 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 /> Owner/Authorized Agent Signature Date (Revised 9723/2016) <br />