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ELEC ICAL PERMIT AP (CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — ta/to t.t..J-e itht-yrs <br /> t;'ttiti/a i ('. Ltie.re.4-f.ep5 G Ve;i'e-Y`1 leJa- ,5 <br /> PROJECT ADDRESS <br /> " I'D l `?`f ? C vL'1LcT(` L�'v-� c! Zo <br /> Owner Mail Address City State/Zip Phone <br /> Thk) ;9T-;. <br /> Tenant j� MailiAddress City State/Zip Phone <br /> livil.p <br /> ut LA lL za I(� Y6 i3o x `jf';f,J Vt t?'I>vvla.r�7 ` r LL ' i <br /> 12-0 201Z, <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> tCf) (1;f ..-e, <br /> Proposed Use of Building Contract Price of Work <br /> a <br /> GAAS iJ TSC-111Ar)4taArt. NyJ Lirov-,1�'Wil <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> • <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: CDSft��l-1L(E7�e ,�,`y $•9'v iN iL,-)0( 42:yi.167.-1- `2_ L,(,ri7"S <br /> ii ) ILA NI lel" ')S "'-t i' c•.t ! <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 r5-b <br /> I hereby certify that I have read and examined this application and know the same to be true and <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 I am authorized by the owner of this property to perform the E 1 otA <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and 1 <br /> 296.200 WAC. <br /> gods" <br /> Signature 1 Da e <br /> REVISED 08/06/2014 t L.L TO e -t/� <br />