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I • <br /> 4FETT 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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 61) I /]`T i-, 1,/, ,ff V1�� ` :�. <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF (090 <br /> BUILDING TYPE: KSFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FA(, ILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: 6Q✓�x� 7/ <br /> EL TRIC L APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ f�'y 2 <br /> NUMBER OF DEVICES (if low voltag : <br /> FIRE ALARM? ❑YES ,NO <br /> ASSOCIATED BUILDING PERMIT#Vtap . ble): / / <br /> DESCRIPTION OF WORK: (/V 1(ri ',/, l{L!y 201- 1,1-) �I ,t ew- 0,07 J 7WI A/7 / <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> - <br /> OWNER MAILING ADDRESS:1)7sTREET tev ,r Dr <br /> , <br /> CITY e✓( r STATE Vie/./7- <br /> 'V/l ZIP 9 g'.2-02 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: uvi't°ei e-7,-(7-6c Xnt, <br /> CONTRACTOR ADDRESS:ITC-0e-STREET /t//[4 P/ �j/'" <br /> f q, <br /> CITY Cj VY?L/( STATE (4/./1 ZIP S/ <br /> CONTRACTOR PHONE:y alci— )3) G/76 CONTRACTOR EMAIL: ( /( 1,.,j f"Clei-�//e-i/,c. <br /> ---$ <br /> CONTRACTOR LIC.#(REQUIRED): Iti`f 1 L7 L-) 75 lie CITY OF EVERETT BUSINESS LIC.#(REQUIRE ):5( ' -(„ <br /> PRIMARY CONTACT: DI OWNER IJd'CONTRACTOR 0 OTHER(Please Specify) Y� <br /> CONTACT NAME: CONTACT PHONE: <br /> 6 14y j y/ // 4i( CONTACT EMAIL: ed t",Y,,r/ ez.7 ,-'C)4(' C. A <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 /> / <br /> City of Everett Official Use Only <br /> PERMIT# <br /> -:," 1//, e';/17 E I 1 , D ( a <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />