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LL�CTRICAL PERMIT APNL�CATION <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 /> PROJECT SITE INFORMATION <br /> PRo�ecT ao�Ress: 7207 Everegreen <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: m COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 100.00 <br /> NUMBER OF DEVICES (if low voltage): � <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: InStall 1 Ilt Wall Sign <br /> CONTACT INFORMATION <br /> OWNER NAME: MUddy P9WS TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: s�xeer 7207 Evergreen Way <br /> �,�. Everett ST,,TE WA Z,P 98203 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Bel'�/$19f1 $ySt@fi1S <br /> CONTRACTOR ADDRESS: s�neET 7400 Hardeson Rd <br /> cin. Everett srnTe W/4 ziP 98203 <br /> CONTRACTOR PHONE: 425.776.8835 CONTRACTOR EMAIL: traCleS@bel'1'�/SIgC1S�/St@t11S.0011'1 <br /> CONTRACTOR LIC.#(REQUIRED): be�rySS853W7 CITY OF EVERETT BUSINESS LIC.#(REGtUIRED): 247H6 <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425.776.8835 X ��4 <br /> Tracie Skiles coNTacr EMai�:tracies@berrysignsystems.com <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know ihe same to be true and correct. All provisions of laws and ordinances goveming this rype <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authonty 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 1 <br /> comply with the State Contractors Law?8.27 RCW and 296.200 WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> 2 2 �� E � �be2-���' <br /> Owner/ t ize Ag t igna Date (Revised 9/23/2016) <br />