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ELECT CAL PERMIT AP (CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857— w/t-v i.e)-4 ye-K-4:H wet.y V <br /> e .e✓ ®s rw - i d V <br /> i,- fl L.C>C.t. <br /> PROJECT ADDRESS <br /> • <br /> • <br /> • <br /> t A ?D 13L1,-7 EVelz-6r l,-> c/ 62•c? <br /> Owner Mail Address City State/Zip Phone <br /> G :,Isri? E ) <br /> Tenant Mail Address City State/Zip Phone <br /> 1'ltcotit.1.k 0, E.k—z`ni2c $r,/ 4.i4. `1 (JD s (Lits) EtZ- z�, IZ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> L;by, E" x. 30 iI'1 YZA.it 1 y <br /> State License Number(required) City of EverettrfB�usiness License Number(required) <br /> Qf) - 11t,r f�l 5 {�J �J 0,_9 <br /> Proposed Use of Building Contract Price of Work <br /> TS G.-V.6,1(441 tJ 1-"z"c -nw 1)h wr.t i L•.I Li"V 1 4:1ww <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: CSM 116 E�`'e{ •�'y 5 gV iN it i�t�''�,:�� 1 v�t - = t ( l7"'c <br /> Jl <br /> ` iv r" ) I I-6)0 S Cr 44 it,0.4 d + <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 4t) .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 l am authorized by the owner of this property to perform the E I-j 1 S -6L-H <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and / l' <br /> 296.200 WAC. - <br /> y 1 r <br /> Signature �j I Date <br /> t <br /> REVISED 08/06/2014 `3 t. 7D c-7-171 <br />