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OLEC TRICAL PERMIT A&LICA°TION <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 /> f + PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4__r4�/4-14re%5eyl //I� — CE'c /`0--7 �� - , �� Ce lel <br /> BUILDING AREA(if residential, new construction, remodel, or addition) /fJ C'' D SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: PZCOMMERCIAL <br /> r <br /> USE OF BUILDING: �G ✓�L-S �G$�:LrT" <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ C1��5 / v� eC 11 r`cetyl �✓! c�C- a 1�`� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / <br /> DESCRIPTION OF WORK: �7pr �j +���G �' d- ear" '� _ Odd iL <br /> CONTACT INFORMATION <br /> OWNER NAME: --/��i j�S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET kDZ �• ��r.� � ���(, /7 <br /> CITY STATE ZIP <br /> OWNER PHONE: ZS-Z 5-/_F 5 j`-,- OWNER EMAIL: del,-It r°� v � <br /> � 4.Jc� .c ' <br /> CONTRACTOR NAME: ^... G2__..._.... .. ._ .�... ._. ..... ... . . ... . . ..... ..... . .. <br /> CONTRACTOR ADDRESS: STREET <br /> Crry STATE ZIP <br /> CONTRACTOR PHONE: `f Z [:'� - CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: _bcx L 0 tek!S 1�1(_ke5-y` of— CONTACT PHONE: Z5_`Z517_ rZ 0f 421fj- QO.- dw- <br /> C lF tO" `% �rA . CONTACT EMAIL: <br /> UGt-1 <br /> AGREEMENT:Thereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws an 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/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 Official Use Only <br /> FEE <br /> P) 0 ✓ <br /> PERMIT# <br /> I <br /> Owner/Au rized Agent Signature Date (Revised 10/12/2015) <br />