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4ffrr 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: I S 2,(5 Ock 5 Ave <br /> BUILDING AREA(if residential, new construction, remodel,or addition) 'l 2 g SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 9 LIOD aje <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES .KNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �Z ( \ 2, - O 7- <br /> DESCRIPTION OF WORK: t‘to q pie..-k-0.0 a 5 a Ira 7 <br /> CONTACT INFORMATION <br /> OWNER NAME: CtaN/\a C Q Y'S 014 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I SZ6 +�y0 C ICe S A /.Q p^7 <br /> CITY eve 1 t STATE A ZIP q O �^° <br /> OWNER PHONE: (92S) 2-to - S 5 S t OWNER EMAIL: a&V Ls d C Y-450 tnvjSyro%a- , co V!'1 <br /> CONTRACTOR NAME: O `e Ol r' \.2.C*-r'.C. LLC-- <br /> CONTRACTOR ADDRESS: STREET 20 Z'3 tD -7 .4 `PL vJ ^� <br /> CITY L y/7/7 v� e 44 STATE [�,a J <br /> A - ZIP_atlo . j <br /> CONTRACTOR PHONE:(4 e Sr)3-z)=7 "t Z") CONTRACTOR EMAIL: 3 Q C-a' C+� lam' e erg.'�@3Ihlai l.Cc 144, <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C7 SS V-41) <br /> PRIMARY CONTACT: ,XOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 04 z.c) S 42> t_') 9 Z aj <br /> SC(40 b ()y k QQ rCONTACT EMAIL: c,C,, b 0 ,�\2 c,c-e( c c. -' C c0'5 - 4.I•CDVI., <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 /> City of Everett Official Use Only <br /> PERMIT# <br /> (14, <br /> yell\ fk,at 2,6)3E � �--o3� <br /> Owner/Autho ed A9 9 ent Si nature Dat (Revised 9/23/2016) <br />