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hLECTRIC A L PERMIT A JCATION <br /> Nillai _-,-� 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.govI www.everettwa.gov/permits <br /> PROJECT ADDRESS: A e: ,C)_.., 5'1__ `�„,, ,c -k\, ,,,,\\ 6•\\ <br /> BUILDING AREA(if residential,new construction, remodel,or addition) \ SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 1C1.COMMERCIAL <br /> USE OF BUILDING: • <br /> ELECTRIC_A__ L APPLICATIONI INFORMATION <br /> CONTRACT PRICE OF WORK:$ q oo '�- • <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): / <br /> • DESCRIPTION OF WORK: ��6-t•-)Ar ',LA\ kc,c 0 v\ VI el Z--'1 c.. (-3A3�N' . <br /> CTINFORMATION._ <br /> OWNER NAME: .. .,\),4z,4^c,`ll \\ L l...0--- TENANT NAME(If Commercial) . •;, \n <br /> S s fo,ws5 ,,\_W T 5 <br /> OWNER MAILING ADDRESS: STREET 14:1\ (Ii va )( -\('& V\k‘Ki., <Q,<0° , <br /> fin\ <br /> �.('V\NI\.G ' cmr STATE ,\ ZIP��1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: () <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR..,, <br /> OTHER(Please Specify) Vc„,..,Q,,.. L HK z rnJ~ <br /> CONTACT NAME CONTACT PHONE: LAO 4.-7 0 c-i <br /> � G— ,� <br /> vv., k-.1 <br /> � _CONTACT EMAIL: r ��� �•La 2" _3 ° `\.<„, Civ` <br /> AGREEMENT:T 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 <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 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> "Z.00 ,-.---_ <br /> PERMIT# <br /> ..*....... ...,.-.1"--e, . \'\ '1/4 ” ‘ ,6(42 — 09 Z <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />