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10127/2015 16:17 4254897� HOME RUN ELECT� PAGE 02/03 <br />ELECTRICAL PERMIT A,PPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR�ET, EVERETT, WA 982Q1 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.gov <br />�IGI ����s ��, <br />PROJECT AdDRESS <br />a� ��n�r� <br />aw�,��- <br />�J <br />Tenant <br />Mail Address <br />Mail Adtlress <br />City <br />C1ty <br />(� ��d�� [ <br />Sta#a/zip Pnone <br />State/Zip Phone <br />�'�Ll �c��� L �. ��� � �1 0`�°�I �� ��-II ��s-��-o�� I <br />�I.��triG�l Contractor Mai] Adtlress Clty StatelZip Phono <br />����a���� ���o�q <br />tate License Number (requlred) City of Everatt Business License IVumber (required) <br />��Y�P.�.�1C�.� -- - - �`�� Db0°a <br />Proposed Use of B�ilding Contract Price of Work <br />1�C�� �c�' <br />Square Footage (If resid9ntial naw construe ion, remodel or addition) <br />Numb�r of devices (If low vbltage) <br />Descriptian of Wo�lc to Be Dane: <br />�1� � �m�+� ,�o� � �oa � ► <br />Contact Person/Con#act Number/Emaik <br />���e : <br />�' eS . �� C o el� �r"s ,�� P� a- u`�, ��c � �.�r5 i�,e�� � �-I� .a1 � �1..�� � <br />C�i �- ��. � � <br />CtTY OF EVER�TT LQCAL SALES TAX CflDE IS 3105 <br />I hereby ceriify that ! have r�ed and examined this application and know the same to be frue and <br />correci, All provisions oflews and ordinances governing this type of work wil! be complefed <br />whather 8pecified hensin or nof. The granting Of 8 pem7if does not presume to give authorify to <br />vrofate or cancel the provisions of an y other staEe or local law r�gulating construction or the <br />performanCB Of COnStruCtlOn. Thaf ! am aufhorized by the owner of tfris properfiy to peiform ft�e <br />work for which &ppllcetlon is made nd ! comply wifh the St9te Contr�ctors Law 18.27 RCW and <br />296.200 WAC. P � � � ; .;' <br />,�"�'� <br />` ,a;�p'� �/. �; �^*�x c�'f'`•,_, ����Jr <br />Slgnature Date <br />REVlSED OB/0&Z074 <br />FEE <br />�V � <br />PERMIT# <br />� ��jlD-ZlJ <br />