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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 ICE)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Y 0t04E `z;)I`,ks1 • b 4 <br /> PROJECT ADDRESS: <br /> .41 of,irfit <br /> BUILDING AREA(if residential,new construction,remodel,or addittar SF <br /> BUILDING TYPE: lA SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> - F <br /> t 4 <br /> CONTRACT PRICE OF WORK $ <br /> NUMBER OF DEVICES Of low voltage); y - <br /> FIRE ALARM? ❑YES LI NO <br /> ASSOCIATED BUILDING PERMIT# it a51 110.. b(e <br /> ;tie4 y�p�.;f��{j '..w •�^ _ ,.ru�.w <br /> j(�(��.x vu ls. <br /> OWNER NAME; ' LA"4.4 TENANT NAME If CottttTttsrolal <br /> OWNER MAILING ADDRESS: STREET 3515e..m <br /> CITY.64/40 STA4 <br /> OWNER PHONE 41,..0 s . 412 7 OWNER EMAIL: <br /> 1OOONTTt 4CTo'R NAME' C: <br /> CONTRACTOR ADDRESS: STREET Ifp <br /> F��'� Wit- ' 2v <br /> CONTRACTOR PHONE t,,,, <br /> Ll 5 crfi CONTRACTOR EMAIL;": +µe 9r herAii ., r 1 i!Yf <br /> � �y •"' ` '-e <br /> 'RED): ? tr Aly't � e <br /> �e • CITY OF EVERETT BUSINESS LIC.#(REQ&UREO} i[ #0` f'..-... <br /> PRiMARY CONTACT• r <br /> D OWNER A CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> ct <br /> CONTACT EMAIL <br /> t a 1'4 dt •, <br /> •AMR lyr;;t harvey,certify that t:have reed and examined this application and know the same to be true and correct. Ail provisions of taws end ordinances governing this type <br /> Of d will he computed 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 t 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 /> *. 13.'5 <br /> OwnettA lhorIIad Agent.stat attire <br /> Date `"(Revised 9/23/2016) <br />