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E�,,IICTRiCAL PERMIT APPLLATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 f FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECTSITEINFORMATION <br /> PROJECT ADDRESS: 011 .5 &err t t-it W <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 6 SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED ❑DUPLEX 17 MULTI-FAMILY-#OF UNITS: %COMMERCIAL <br /> USE OF BUILDING: Rola i J <br /> ELECTRICAL APPLICATION INFORMATION • <br /> CONTRACT PRICE OF WORK:$ I coo <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES '�NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: PI if iC4 . (4 r t o a ' na fhr <br /> A-dot Ainio papel yr (,c.,! cc/Paler/ c re (/ <br /> elf* <br /> CONTACT INFORMATION <br /> OWNER NAME: /.L,C/1 I)OSC },�PO <br /> ,/��`y TENNANTNA f erciip <br /> OWNER MAILING ADDRESS: STREET i7 2 l- 19-62 <br /> CnY PeCiONdit y� STATES14/11-) _ ZAP l g 3 <br /> l OWNER EMAIL: 1 Cd t SCh Y�19 1/ + (( P1 <br /> OWNER PHONE:�CS�p^ � � .. ,,�.//''��� �J --{-/� /� _y p(�,/ J�/� <br /> CONTRACTOR NAME: eCA- f �-1 C..- -I LT` 2 r " `8 <br /> ADDRESS: STREET I I_,• ���(7,f, /916. S. /, <br /> CONTRACTOR j_t TATE }/t iCt LP qAa f,� <br /> dTY 4 ! tONTRACTOR <br /> crl/l W 7 ,RC1 <br /> EMAIL: r j Cork I t e ['4' ma>'/. C� <br /> CONTRACTOR PHONE:��Q"' lO"" 1' �! ;��� <br /> 1 & 'CITY OF EVERETT BUSINESS U ..#(REQUIRED): (96ft <br /> CONTRACTOR LIC.#(REQUIRED): ��/ <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: c) ( 610 e ctV3 <br /> Rth (Jerk CONTACT EMAIL: (-Oa ct !main co <br /> AGREEMENT:I hereby certify that t have read and examined this application and know the same tb true and correct. AU pmvis taws and ordnances governing this type <br /> of work will be completed whetherspecifred herein or not. The granting of a permit does not presume to give authority to violate or the provisions cf 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! <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> lit(k <br /> nvpiLo- // 7 (RevisedE 1 q0Z -� - � sre�2o�s� <br /> Owner/Authorized Agent Signature <br />