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Nov.24.2015 �:�9PM <br />� <br />No, 0991 P. 2 <br />ELECTRlCAL PERM[T APPLICAT�ON <br />CITY OF EVERETT PERMIT S�F�'1/'�C�S <br />3200 C�DAR STREET, EVERETT, WA 982Q1 <br />425�257�8810 - FAX 425-257-8857 — www.everettwa.org <br />�� l �) . �� � �j )r,v���. _ C) ��_� <br />PI�OJ�CT ApDR�SS <br />Ownor <br />Tena��t <br />'��� I �� .� - �i � � �'«lrt�- � �J �/ <br />Mall ddross City <br />Mall Addrass <br />, ._. : .� <br />� �.:1� �� �� ��, ��L=� �-c �� �-- �_ _ S-tij <br />StatelZip f'thone <br />....._ ....... ..... .... ....-- <br />Cify 5tate/.7_ip Pliun� <br />_ �, ?'t_�'� �-C J Q� ��"�`(19, ��'�� -��U-c�Q�`�- J��'�C' - � � Iei��C � n I. C.% 1 �{. tS •� Z.s, �l: ..1..�� � U :%�. <br />Electrical ContrflctoC Mail nddress C;;ly r Sl21BILI� Pl�one <br />E�>�'l � ��S t��;3U�(7 �— <br />State Licertse Number (required) <br />���i Q�1� tL� c�.9 <br />Propo ed Use of F3uildiny <br />� <r� ���: � <br />5quare Foota�e Qf residenEial new consfrucffon, remodel or addifion} <br />Number of devices (If low voli9pej <br />Doscripfian of Work to 13e Done: :_> �\�R (� 1��„ (} ��� � <br />_ __.�. , ` <br />CfTY OF �V�R�TT I.00AI. SALES TAX CODE IS 31U6 <br />�� `�i �.a ��_ _ <br />City of Everett �usiness License Number (required) <br />% ���� <br />Confract !'rice of WoCk <br />'�ul_� U'.�e�.�l�Vti�,�i/ <br />Co��fact Pe,rsonlGon#act Number/Email <br />C� iJ,�t.FJ✓i �..�'�����_uRk�l�i�` (.��/��., <br />I he�eby ceilify lhaf 1 f��ve ���d ancl ex�vl�ined fl�is �pplir.atinn and kr�ow fhr samr to be trcrc and <br />cnn�cf. Au provisrons of laws and ordrner,ces �a vem/rtg fhis (ype o! work will be complefed <br />wilelfrer specifiad hej�el�] o�� t1oL The �I�nti��� o( a po�mit d�cs not prosume to give authority fo <br />viok�to nr-r.anr.el the pmvisions of �ny otiler stvle Ut IUC�I l�W t'B�ul�fi�1C� co�Tstt1lctiol7 oY tf�6 <br />�erfUrrnsnCe Of Cons(I�UCtlol7, Th�Zf l��rn a(Iff7orizcd hy !hc owncr af fhis properfy to perforrn ttie <br />��ork tor whr.r.h spplicatra� is msde �r�d I co»�ply 1rol(1� (he S(ate Cot�t����cfol�s !„�w 18.77 RGW �nd <br />296.200 WAC. . <br />� <br />REV1SFf lOfutYM0�l4 <br />I f� �l l� . <br />FEE <br />� � � �� <br />PERMIT� <br />E���;���- ��,� <br />