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• � <br />ELECTRICAL PERMIT APPLICATION <br />� �j <br />PROJECT ADDRESS <br />� t � K� <br />Owner <br />Gf �ui [�!� � c �lAl <br />Tenant <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — t.a,� �v �-� �����`� s�v� .�;� ;�` <br />e �ti1�ti � 1: .� vr� re�-�-.e P s � � v-�r�'�� ��� � � �' <br />1� ! �"� �: <br />i a �izi�� I Fj`'j��! <br />Mail Address <br />G;'iY -� �. <br />Mail Address <br />t �s}�� <br />City <br />City <br />i,��� 1 �- z � � <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />�� 1.�� U. i.a� {� � �C�'�12 � L-- PL Y, b X `� � L� �i 1'-� i�J� ) y�,s � G' �' ' <br />I v�'�'S ( �Z•,-)E2Z-Z�tZ <br />Electrical Contractor Mail Address City State/Zip Phone <br />El'�'�. �b�,�� � 34� �.�-1 ��� � �`i <br />State License Number (required) City of Everett Business License Number (required) <br />� � 1 � �� 1'-�( � L'�.��1`� L.,� `�� � ��� � �/ <br />Proposed Use of Building Contract Price of Work <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />Description of Work to Be Done: ��S <br />I� G�"W&. r� i.l 'f 'S' c' - i'►'W �a �+R t� ,v �,.i �i,.,6c., l <br />Contact Person/Contact Number/Email <br />�' $ �lV i N �; r�,r-1"i.y,�(l�l� ��v'. <br />��� ni � ,^� a 1 r�� ti � l: i�� ti ) S ��� ;- `5 . � , <br />CITY OF EVEREIZ' LOCAL SALES TAX CODE IS 3105 <br />l hereby certify that l have read and examined fhis application and know the same to be true and <br />correcf. All provisions of /aws and ordinances governing this type of work will be completed <br />whether specified herein or nof. The granfing of a permif does nof presume fo give authority to <br />violate or cance! fhe provisions of any other state or local law regulating construction or fhe <br />pertormance of construction. Thaf 1 am authorized by the owner of this property fo perform the <br />work for which application is made and l comply with the State Contractors Law 98.27 RCW and <br />296.200 WAC. <br />1fl' /a-- l5 <br />REVISEO 08/06/2014 � � ' `� �` J.� /� <br />�c� L s <br />LiC'r-i7.._S <br />FEE <br />0� <br />�y .� <br />� � <br />PERMIT# <br />E I�l o � ��j"� <br />