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1��OV/2�/2015/WED 10; i0 A�� Green��,�ood. Heating �`AX Nn, 206 4c�2 621� <br />�LECTR�CAL PERMITAPPLICATION <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 CEDAR STREET, EVERETT, WA 9�201 <br />A�25-257-8810 - FAX 425-257-885� — www.everettwa.gov <br />`� �\r�i 1 � i' Yl 'A�� U��r�.. W A <br />pRO,lECT ADDRE <br />�wner <br />7enant <br />�S �(0�1 <br />t..,)� SM � ��c--�r-i c <br />Electrical Contractor <br />Mail Address <br />M�il Address <br />�as � � <br />� Mail Address <br />�S�l n� silt,.3 � a,5 l�f� <br />5ta� L4cena� Number (required) <br />Propos�d Lise of Buildiny <br />Square Footage Qf residential new canstruction, remodel or addition) <br />Number of devlces (�f 1ow vo�tage) <br />Descripfion of Wark to Be Done: <br />. �� l `J Y� <br />C�i'TY 0� �\7�1��7T LOCAL 5ALE5 TAX CODE 1S 8'1�6 <br />c�ry <br />City <br />C�ty <br />Slace/ZIp <br />State/Zip <br />� 3'-� <br />State/,Zip <br />F, 001/001 <br />a�b <br />.1 3 �� <br />Phone <br />Pfl6tle <br />�n � <br />� ,,- ass <br />Phone <br />�� 43�C�2_ <br />City of �vereft �3usiness License Number (required) <br />�'I-t�� - c� � <br />Contract Price of Work <br />�c� �,otn•�vj -o�lSc�S <br />_�`C��c�. ��i0.S�-U'�� ��� ��nP1��i-t�• C�r�'+ <br />Cantact Personl onta�t mber/Email <br />I heroby csrtify that I have read and examined this sppl/c$tlar� &nd kno�v the same fo ba true and <br />correct All,�rovisions of /aws and ord/nances yoveming thrs fype of work will be completed <br />whether'speGfied hereln or nof. The yranting of a,�errnit does not presume to g/ve auThonty to <br />viol&te or cance! fhe provrsions of any other state orlocal !aw regulaf(ng construction or fhe <br />performance of construction. That ! am authorized hy the owner of this properfy to pertorm the <br />work for whic�h a�plicat� n� made and / comply wlth the Stafe Confractors Law 98,2� RCW and <br />296.200 W�fC_ \ � <br />IE/� <br />REVlSED OSN6/2014 <br />2i <br />FE� <br />� ����� <br />PERMIT# <br />E����- ���, <br />