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LECTRICAL PERMIT A, i'LICATION <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: U �o + <br /> BUILDING AREA(if residential, new construction, remodel r addition) n rC: (.% SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ )j) --�- I C-,kx <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? DYES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: , \ (AIAI_evS cA�k <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET .:) <br /> CITY STATE ,J ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: "�G CONTRACTOR EMAIL: �ASp h Cav IS 6 ����, ) �C G m <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: AOWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �^� L <br /> r G CONTACT EMAIL: -i <br /> AGREEMENT:T hereby certify that/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 l 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 /> ' 3 <br /> PERMIT# <br /> ZL <br /> Owner/ thorized Agent Signature Date (Revised 10/12/2015) <br />