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ELECTRICAL PERMIT- PPLICATION <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: 2� 2. ���,, � arc' <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)O D <br /> NUMBER OF DEVICES (if low voltage): (" D, <br /> FIRE ALARM? ❑ YES f4-NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: <br /> ,4 4-- <br /> J <br /> CONTACT INFORMATION <br /> OWNER NAME: Ship v TENANT NAME(If Commercial): o <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: LLC-- <br /> CONTRACTOR ADDRESS: STREET ll ,, -c_ <br /> CITY � STATE ZIP <br /> / ZIP <br /> CONTRACTOR PHONE: 24,--1 5_621 1CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER b4XONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME; CONTACT PHONE: 22�,_ DS4-+ <br /> 14,_ ku-14G/`r 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 Officia Use Only <br /> FEE jj <br /> G� <br /> PERMIT# <br /> Own r/ uthorized Agent Signature Date (Revised 10/1212015) <br />