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08/27/2015 20:43 <br />#7221 P.0031003 <br />ELECTR�CAI� PER�NIIT ,A�P�,A�ATt�N <br />CITY O�' EVERETT I'�RMIT SERVICES <br />3200 CEDAR STR�ET, �VER�TT, WA 98201 <br />425-257�8810 - FAX �}25-257-8857 — www.everettwa.org <br />l� �' .S � U �1`l�r�.J /� -- � <br />PROJECT ADDR�SS � 2� <br />.� �y ���% <br />Sl��-c�ac�. �S t�°"z..���-�' �'�a� �2r�c�� <br />�wner Msil Address City State/�ip Phone <br />Tenant <br />���� ���� � <br />Electrical Contractof <br />Mail Address <br />�o �o.� i <br />Mait Addrass <br />���-e�r��f.� � �2 �� � <br />State Licens� Number (required) <br />��� , <br />Proposed Use of Building <br />Square Footage (if residentia! new construction, remadeE ot addition) <br />Number of devices (If low voitage) <br />CILy <br />Gfty <br />StafelZip <br />[�-^L��//� � <br />� st$celzlp <br />j A� Phone <br />0 <br />�� �i <br />Phone <br />o/���.� <br />City of �,verett Bu5i11ess License Number (required) <br />Contract Price ai Work <br />Contact Person/Contact Number/�mail <br />Descriptian of Work to Be pone: !V ����� �� �� �� ,��M,� �` <br />e j�1`! � <br />CITY OF �V�RETT LOCA� SALES TAX CODE 1S 3105 <br />I hereby c�Rify that I have read and examined this appllcatlon and know the samB to be true and <br />correct. A11 provisions of lsws and ordinances govemJng this typr� of work will ba complefed <br />whather specifed here/n or noi. Tha granting of a permit does not presume to glve authority to <br />violat� or cance! the ptovisions of any oth�rsEate orlocal !aw re�ulating constructlon or the <br />performance of constructlon, 1"hat I am authorized by tha owner of this property to perParrn the <br />�vork for which appll ation is made and ! comply wifh the 5tate CoRtractors Law 98.27.RCW and <br />296.200 WAC, /� . „ <br />re <br />oa/os/�oya <br />FEE �f� <br />� � � <br />Q� <br />PERMTT# <br />� 1�b�J- ��� <br />,� <br />