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LIECTRICAL PERMIT APPLICATION <br /> O <br /> lliiW 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 I www.everettwa.gov/permits <br /> it ° 0!PII,Ma o1 il)i ii( ,< m u ni r i; , omo it Iu s a A <br /> �I ROJE"CT SITE INFORMATION <br /> n�v,c, ��p n .- �-r ... ";TM+.i�..A..,,, Tnh3d'a;...C", v b.•, S <br /> PROJECT ADDRESS: &%3 a/6 ., AI/J' <br /> BUILDING AREA(if residential, new construc4Cfon,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: )(COMMERCIAL <br /> USE OF BUILDING: /16111' <br /> ELECTRICAL(APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ a,g 00— <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES Jar NO ,c� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t.t W l ft"'V�0\ <br /> DESCRIPTION OF WORK: Z,...(S7.4l/ /,v/Ifhva A ) I APt • /RICE'S <br /> "CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): 14401/VVI Ot-': (Piritidani <br /> OWNER MAILING ADDRESS: STREETt/1 <br /> �+ <br /> CIN STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ,„Tin jj kt g/V riet h c, <br /> CONTRACTOR ADDRESS: REET /)0 /6.67 52 Mr' Sar .1 <br /> cITiA , , ) ,O STA A ZIP <br /> ,02,04139 <br /> CONTRACTOR PHONE: y,�.v Al•2`,i4 CONTRACTOR EMAIL: /,�( 5� ,6eo `� ,Q Fh 1c'601 <br /> CONTRACTOR LIC #(REQUIRED) 6m O K(P j 939 CITY OF EVERETT BUSINESS LIC#(REQUIRED): 01/gsy9 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR <br /> �naa� � . � OTHER(Please Specify) /� �{. �+v �/� ..,�.�,. � �� w <br /> CONTACT NAME: CONTACT PHONE: 4/ ,..(-0 ,• f3'79 /,� <br /> eM CY l d !/t k, CONTACT EMAIL: /ECS ,f,,„6 C�. 9j" 1 "c' ( „6)41 <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and c'"rrect. All pro�ois 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 ROW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /Ty /� E I b01 - 2.O7 <br /> ner/Autho ed Agent Signature (Revised 9/23/2016) <br />