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07/16/2013 16:04 FAX 425 257 8857 EVERETT PERbiIT SERVICES <br />ELECTRICAL PERMIT APPLICATION <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />ZSI D L�.� • � �n�a 2o,q-� <br />PROJECT ADDRESS <br />� ooiiooi <br />M A JL�S T� c �o !o,/E 2.f/o u�, �'.rs i„�o 2r/ ��� w.�t �� Zo � <br />OwnBf Mail Address City State/Zip Phone <br />i�F}G/�jC �N(o�Ne'�1L/N% <br />Tenant Mail Address City State2ip Phone <br />jl, a��� L�z�ic ! N � ���L6 `''� `s ; n� w�`� o � ��u�e,� wr�-9�cr� � z.�3 -�rs r-�„o <br />Electrical Contractor Ma�l Address City State/Zip Phone <br />l�i �e►� YEr�� � g nJ i-�3-�S�xr • <br />State License Number <br />f�-v r�%t C� , S- sTa �a .�-G � <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (Ii low voltage) <br />3 r�, �� p r7 <br />Contract Price of Work <br />rp/f- v� 1�f�S,�/NS <br />Contact Person (Plan Review) <br />Description of Work to Be Done� /¢c�t�i-�io,� � Gr� �¢/��,.� s�a�CiK �o �' '7`{� r'- � ic�.� ro �e� �% • <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! hereby cerfify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of woric will be completed <br />whether specified herein or not. The granting of a permit does nol prEsume fo grve authority to <br />violate o� cancel the provisions of any other state or/ocal law r�egulating const�vction or the <br />performance of construction. That I am authorized by fhe owner of this property to perform fhe <br />work for which applicafion i made and I comply with the Stafe Confractors Law 18.27 RCW and <br />296.200 WAC. <br />nature <br />REVISED Y70/13 <br />�-/6 -/ 3 <br />FEE ��� � <br />PERMIT# <br />E � �07- v7� <br />