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ELEC1ICA <br /> L PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — IA;Zv t.c)-e Vire_` mt.-LI V <br /> e i„,,,..,. I'. L✓g.;e+-1-.e/5 64 6 tM-ve-i WA j E,V , <br /> 60y (,I 7--)D En <br /> PROJECT ADDRESS <br /> • <br /> 1 A PD .134/. i 5".1.-? E vc); -T i,-) 7 2,0 <br /> Owner Mail Address City State/Zip Phone <br /> Gi ii.1Nl)UtC-w 0 't3. <br /> Tenant Mail Address City State/Zi <br /> 1 n P Phone <br /> ,J 1tia. 61 v0L'S (y7.}) bLZ 2olU <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> lAii.CbV%l, z 30 'Ll ► 'I <br /> State License Number(required) City of Everett Business License Number(required) <br /> ; P ,r��11:o---,U l; 2 1 , c o1 <br /> Proposed Use of Building Contract Price of Work <br /> Tr eµlA4E..a-i .) 1-z--6--111.09,44•A;1.1.& 1111,)L4(0(.4110'1/1 <br /> Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: COS/v,,:.MC/ t-NC-Z,j,y 5',V if-, u tl„---(c..:vrrcVv167,1.t- (,:16;-t7 1 <br /> `ii\'Tl-. FA, . > ) rua ,;e f- �ti>j 1 3 4,-t 4-4-pi / 7-3 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 / `1 <br /> I hereby certify that I have read and examined this application and know the same to be true and Vll 1 <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That 1 am authorized by the owner of this property to perform the E i O' I IA <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ;1 <br /> ___,:).47,-, <br /> Signature �^ <br /> e <br /> i "at <br /> REVISED 08/06/2014 3/•`t-- -p\ l..-/-t-il <br />