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ECTRICAL PERMIT AP ICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 { (E) everetteps@everettwa.gov ( www.everettwa.gov/permits <br /> �"'ii�+C�J��T S1"�"�' Nh��t`��I'�ATMQt`�1 <br /> PROJECT AI}ORESS: 6�o r ri�r�.i���;on �:�ad <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 1(��� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS:,�,� � COMMERCIAL <br /> USE OF BUILDING: �,�,�,r,,,r,,�.� ��� ;�,::� <br /> �;'C�.��:"1"R�I�"r/`�kL.APPt.1Crl'�1TMCINM N�M�'�l�M 'JI�1"�I"ICyN <br /> �, __.. <br /> �ONTRACT PRICE OF WORK: � 13��� <br /> NUMBER OF DEVICES if low v {ta e : � <br /> ; <br /> FIRE ALARM? ❑YES f�NO <br /> ASSOC{ATED BUILDING PERMIT# if a licable : <br /> �DE$CRIPTION OF WOR�: Acic= t3) new �:ir�uit�� ic�- r,�ic_uwav�� �ri:,' mo=r�� r�c�we: t`c,i c�rl �.r���s; <br /> , <br /> coNTac�r ����n�M�r�oN <br /> OWNER NAME: � `�'�1(.;�',�';- __��-_�--.',._L,:_ L TENANT NAME(ff Commercial): u,nbra cuscinetti <br /> OWNER MAILING ADDRESS: sTkeer 670; Na�rdFson Road <br /> aTv Eve•e:.t. srnTE w;� L� <.7<0:> <br /> OWNER PHONE: ��°� ��S j`�� OWNER EMAIL: <br /> CONTRACTOR NAME: `tir3�].ey �:Le:t i::: Cc:� oi: hti: `Jernc�n <br /> CONTRACTORADDRESS: srHeer 1':t;G I�erc•111 Creek [:�ar�wr;y <br /> c:�r� �.veretr srnTE '��� ziF� ',, <br /> G_.� `, <br /> CONTRACTORPHONE: a�5 �« �'9z� CONTRACTOREMAIL: peLmitsC�velectric.�.;r, <br /> CONTRACTOR LIC.#(REc]U�RED): vALL�:rcl9 iN� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ��� <br /> . <br /> 'PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) __,,.,._,,,m, _��— � -..'�.-e-->—. <br /> —�- <br /> CONTACT NAME: cASE coArr CONTACT PHONE: zoh.ss�.eis� <br /> CONTACT EMAIL: cPrr.c?vsLEc,Rz�.corr <br /> AGREEMENT. T hereby certify that 1 have read and examined[his apptication and know the same to be irue and correct. All provisions of laws and ordinances governmg this <br /> rype o/work wilt be compiefed whether specified herein or no[. The granting o(a permit does not presume fo give authonty to violate or cancel the provisions of any other state or <br /> bcal lew reguleting construction or the performance of construction. That 1 am authorizad by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Confractors Law 1 B.27 RCW and 296.200 WAC. <br /> Cfty of Everelt Oificial Use t7rity <br /> FEE <br /> <~�l ' `J l_.- <br /> � � PERMIT a# <br /> � ,� 3 9 <br /> , <br /> U � <br /> �.,� �, r� �� � ����� � E �� � - <br /> � f�` ;� � _ , . �� � �� <br /> Owner/Authorized Agent Signature � fat ( ) <br /> Revised 10/12/2095 <br />