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ELECA.ICAL <br /> PERMIT AP LIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - tit/Zv t.r)_, Ve-Kt-f-r WeL y <br /> eh.(A , ('. .evere-I--1-etos cw-ve.-t &Jai d <br /> L-I MbEra <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> `i411`() <br /> Tenant Mail Address City State/Zip Phone <br /> �f tkti) Uk? �GZ t L Po 136 X `1(3L t �� 4, <br /> � . I vGQ3 (Li Z5) r:2Z-zotZ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> cD"Lt z 3u(6 Li 'C-•(--► <br /> State License Number(required) City of Everett Business License Number(required) <br /> E��s�;�T1�Li1\ri5 <br /> Proposed Use of Building Contract Price of Work <br /> --TTC s uri-1) ( .-&-vvw,D.;u,44-1. "V.;LI N V_,1014 <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: CCS1A,T1L((-)—EZt Y 5 V i N iLeyi,.:l .ct 67 i typ- L.i6riT- l <br /> S � �-- LN2 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 4t573 <br /> v <br /> I hereby certify that l 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 I - 615 <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 1 � T l � v� y � ��� f `9 <br /> /�0 <br /> Signature <br /> IIJ Date <br /> REVISED 08/0G/2014 3 t G L TO J fl <br />