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qLECTRICAL PERMIT AALICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> OR®JE : PIIlE 0 OORtll�liAION <br /> PROJECT ADDRESS: sZ <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 APII LICATI10H NFORMA` ION <br /> ECONTERAG-TFRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage):- <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CZ <br /> CONTACT INFORMATION <br /> OWNER NAME: L,ti l? L. TENA T NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -L6 cSC - <br /> CITY STATEWC( ZIP <br /> OWNER PHONE: s— Z OWNER EMAIL: ��11C-X�yol <br /> CONTRACTOR NAME: <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: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Q CONTACT EMAIL: <br /> AGREEMENT.-Thereby certify that/have read and examined this application and know the same to be true and correct All provisions oflaws 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 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 /> o <br /> -7 PERMIT#en <br /> 1 <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />