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Dec. 2. 2015 9;ObAM <br />Sou�Securlty Inc <br />-� ' , <br />No, 0202 P. 2 <br />w`,� <br />�LECTRICA,�. ��RMIT APPLIC�4T[ON <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STREET, EV,��ETT, WA 9820'f � <br />�25-257�8810 - FAX 425-257-8857; ,,vuww.�ver�tfwa.org <br />� ���j ' • <br />� <br />�� �,�.3 �� � �� � � �� � D � �� ' <br />,;; . <br />PROJECT AbDRESS <br />'.� t <br />Owner <br />�'" �iC <br />Tenant <br />Mail Addross <br />Mai! Address <br />; <br />� n ��l�of ��c��c. c2a�� ( �����r1 <br />Electricat Contractar Mail Address ,. <br />�N � i �� G ���� <br />Stafe License Number (required} <br />� ;�Y�t'r� %� �'�.-��s.'-' (��� ( `� �, <br />Proposed Use of �uilding <br />__- <br />Syuare �oatage (I# residential neW constructios�, remo� el or addition) <br />'f ( 1 <br />o � �. <br />Number of de ices (If low voltage) <br />Description of Work to Be Done: <br />e <br />City State/Zip ( p_Z��_ Phone <br />, � _, <br />!� f(�`� �� CI �j <br />City <br />, <br />5tate/Zi� Phone <br />�z� -- <br />,���„ �� r z���.��s.5 <br />City State2lp Phone <br />i �I �--�-� <br />City of Ever tt Business License Number (required) <br />1 y� ✓ � . J \ \/ <br />i � — <br />Contract Price of Work <br />��..�, � ZS�� � I � �i <br />Confact Per on/Contact Number/�mail <br />� C��� �� �. <br />� E _. A�_ <br />�� <br />' � �= FEE <br />� r <br />CITY OF EVERETT LOCAL SALES TAX COD� IS 3105 . � l� O�! <br />1 hereby cartify ffrat I hsve read and examined fhrs applicafion and know the same to be trua and �� <br />correct. A!I provisions of laws and ordinances c�oveming thrs type of work will be complsted <br />whetherspecifred herein orna#. The grentin� of a permit does not presume to give authority to PERMIT# <br />violate or cancel the provisions of any ofhersfate orlocal law rsgulating consfruction or the <br />performonce of constructfon, ihAf I am authorizod by th@ owner of thls property fo pe�-form the E�" '� y�� ��� <br />work fo� which applicstion is made and 1 comply with the 5tate Contractors Law 95.27 RCW and <br />296.20 WAC. <br />.� r � � <br />-�� , � 2 ; Z �' � � . <br />fE <br />aEVISEO 08/0:/Zo 14 <br />DaEe <br />