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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 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT ADDRESS: , nrr <br /> BUILDING AREA If residentlal,new construction,remodel,or addition) SF <br /> BUILDING TYPE 8FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#,OFUN}'I „ ❑COMMERCIAL <br /> USE OF BUILDING: <br /> < k- �'K o '� e ti- ' ti S� a ✓r r . <br /> r.,r�f "' � <br /> CONTRACT PRICE OF WORK: $ 0 ,too <br /> NUMBER OF DEVICES t`;low vislta <br /> FIRE ALARM? 0 YES HO <br /> ASSOCIATED BUILDING PERMIT# ' asplicable)_ <br /> a•';,• ', ° <br /> � a' e'*q.14'4 4`4.• r-a a c,;.r . 44 °cam . " a ... -_ <br /> OWNER'NAME• . ` TENANT NAME If Commetolat <br /> OWNER MAILING ADDRESS: STREET oe <br /> ciT f. STATE ZIP <br /> OWNER PHONE COP, „ d , OWNER EMAIL: <br /> CONTRACTOR NAME: Ai k s <br /> Ottv 'A MATS A 44` ZIP 40 <br /> CONTRACTOR PHONE e ' ".a CONTRACTOR EMAIL: <br /> AktllYTm CON f4m# teoutt t7 e:� df't a <br /> TACT: 0 OWNER aCONTRACTOR- 0 OTHER(Please Specify) <br /> r <br /> CONTACT NAME: <br /> CONTACT PHONE: 11 Qs 9q <br /> 1 ''el/Chafe CONTACT EMAILt 'Vie= ctir)01 <br /> AGREEMENT I hereby certify that. have read and examined this application and know the same to be true end correct. All provisions of laws end ordinances governing this type <br /> !Deal taw re <br /> of work wilt 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 /> gulating constnrctIon or the performance of construction. That I am authorized by the owner of this property to perfomt 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 /> E 1 —ant _ r�,, 5�.'' <br /> rierfA,t#tiorizeo Agent•Signature " �10�fJO. <br /> Date (Rev/sad 9/23I2010 p"" <br />