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F�ECTRica� PERMIT LICATION <br /> I�0000. <br /> ►�;siiiCITY OF EVERETT PERMIT S r<VICES <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: 1 91'IO -( J V i'ei�t I v jl q O o <br /> BUILDING AREA(if residential,new constrbction,remodel,or addition) D Q 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:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �' P6(Ot U- el�'c (u U CSO 1-e <br /> CONTACT INFORMATION. <br /> OWNER NAME: CSL i C ,u3a vc d TENANT NAME(If Commercial): N A- <br /> OWNER MAILING ADDRESS: STREET I f LI- Di,.((ljn/I.J)V'} Ni <br /> CITY Save I V .Q '►f►r�: STATE v\J✓ 1 ZIP , <br /> OWNER PHONE: 2_0 -9-jg®Gj' Ii,P EI.,. ..WNER EMAIL: 0.0,11i ea.VI I1-0 -C f.Cr ISYIA <br /> CONTRACTOR NAME: Q N kNo,l f <br /> CONTRACTOR ADDRESS: STREET jyl.{ <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: J A.& CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):'"` <br /> PRIMARY CONTACT: ,eWNER 0 CONTRACTOR 0 OTHER(Please Specify) """ " <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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 lam 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 /> FEE <br /> 41 ,D-S <br /> PERMIT# <br /> (4.- <br /> g/ I � E \ � �EE <br /> O u orized Agent Signature Dat (Revised 10/12/2015) <br />