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OECTRICAL PERMIT AI0LICATION <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: v-r n a'-_ 0 t�'b— <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: E nui�c ct� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 7C-,r "o <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 9NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: n-5( cz I ori�� C n vn C r-(t�Vt G i v�ro <br /> j cam, c off� l <br /> �}-� —T7 CONTACT INFORMATION <br /> OWNER NAME: ) J:C" c \v\OvyLots TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY ���r�5 1 `�— STATE -�C ZIP <br /> OWNER PHONE: 2C e OWNER EMAIL: A ,,P c " vin a•s �' �e'f4�naCI G� e <br /> CONTRACTOR NAME: 5,A-C) <br /> CONTRACTOR ADDRESS: STREET <br /> CITY COSTATE ZIP <br /> CONTRACTOR PHONE: [CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 4 OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> � <br /> p �o n rzJ c�� � vv��t5 CONTACT EMAIL: c�a�+ < `f v\oti C� �� 'n�� I• A" <br /> AGREEMENT:Thereby 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/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 /> 4 <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />