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S <br /> 477- ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> / PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: , 3`f <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 6 4v SF <br /> BUILDING TYPE: 0 SFR-DETACHED 9v-SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: /Z E T-T(, -( <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ S w <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES E rNO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: A) J S-11-64:3 , /1-DO t( f1477/Lei /A/ 4 f/ ate <br /> L n CO'i' GctJ[ T-C/-7�SS <br /> CONTACT INFORMATION <br /> OWNER NAME: i�-(1 ( y 11 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ( kJnAlT L - <br /> cITYSTATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �� �� L /L.(C 1 t\iC <br /> CONTRACTOR ADDRESS: STREET Z t3 AiZ I®L2_ <br /> CITY �`Z4_,.. STATE (4k- ZIP G Cj 2,1 <br /> CONTRACTOR PHONE: qZ -Z* -8g5C.) CONTRACTOR EMAIL: JSGte_c_—r"ice,aa7Ye6 , L'CJuti. <br /> CONTRACTOR LIC.#(REQUIRED): C 6C—� �5 7.e CJL- CITY OF EVERETT BUSINESS LIC.#(REQUIRED):,53 777 <br /> PRIMARY CONTACT: ❑ OWNER R CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: //z5"----2,1746— <br /> S-A9-1 <br /> fz5_2,t746^S-A9-t CONTACT EMAIL: vk.;e-� L_<"��d'l C. jptLi <br /> �f.t ( Z.c.z i <br /> AGREEMENT:I 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 type <br /> 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 /> PERMIT# <br /> _ E - LS <br /> Owner/Anti-100.9d ,gent 'AMP, re Da e (Revised 9/23/2016) <br />