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ELECT ICAL PERMIT AP ICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — tz.f �� i=� �' _� +��-�-�::—"`��' c.��:� _ ��;,� .;. <br />, _. <br />� �Lti/,t. l r': -�. �1 L o�'T`� •L /� S�/"�G:- i�F,-1`t'it'�"�� ilt:�r!�- . �;i 1� iy , �.✓ <br />ti� <br />r '� ' :, <br />L e': z� f r �. ,'r i�' <br />( sa („ <br />PROJECT ADDRESS <br />� �' K! �' a i:� � �< l +'�'� � � <br />Owner Mail Address <br />t�i;\'' ` � <br />��"u:b u r �`��..; C'',1 r'`i _ <br />i <br />Tenant <br />Mail Address <br />� V c 1���r�" <br />City <br />City <br />G —�a� �j �� Z �' ( <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />����U:,�i)Lt ���;'"- �i,CZ''fi =lC. � G i:'S G1, 1. �",�, <- ��,, , <br />� � X `� � � ,� . � � ,�- i.�as., �� L�.? � , I v �� �' 3 � �� ?, ti � � ") Z - Z c� l L, <br />Electrical Contractor Mail Address City 5tate/Zip Phone <br />���4�'.. �.:%IjLI l. t:(- ,�,� U`� L•�r� �-' r�`'' � i`( <br />State License Number {required) City of Everett Business License Number (required) <br />,�'�P�at�r�L+.���� �� ���� �"�i <br />Proposed Use of Building Contract Price of Work <br />Square Footage (If residential new construction, remodel or addition) <br />a�.,�� <br />Number of devices (If low voltage) <br />� C..-'.-WtS. �`c� h.3 i S�- - Ww h� �.�; c,. �� ,v ,,.; �; N v,!� <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: _ ���S�U"-"l�L/ C`�)'�e� �j S-'=1'v i N � �� t�f>�,<��_�-y���:���.#_. �,-� �,�;_��.•� � <br />``Q�3`n-i 1=r1;� � l ��o� �v u�' IK::L ) � a Vr'.�.�- ��T = r' r � { r -r.. <br />C1TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />l hereby certify that l have read and examined this application and know the same to be true and <br />correcf. A/i provisions of laws and ordinances governing this type of work will be completed <br />whether specrfied herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of consiruction. That I am authorized by the o�vner of this property to pertorm the <br />work for which application is made and 1 comply with the State Contractors Law 98.27 RCW and <br />296,20� WAC. <br />G� <br />G� <br />ure <br />REVISED 08/O6/2014 '� � ' � � —�\ � /`� o � <br />! t� ( 1 <br />•'S <br />FEE <br />,� ��� �,� <br />PERMIT# <br />E l � C��' � �f I <br />