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� <br />ELECTR�CAL P�F�MIT APPLIC,�4T�QN <br />CITY QF EVER.ETT PERMIT S�R�1/'ICES <br />320a CEDAR S7REET, EV�R�TT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />���6 t�� � �t4J�+ � A.(%' �.�f��T �.✓.,�}-� Q�15 %�lo�s� i7o� <br />pRO,�ECT ADDRESS <br />!''�A�f'� ��=�f � �0�3( /�� 112 5'� r����e'r��t� 4803 {/Zs'8zZ tllG, <br />OwneY MaII Address City State/Zip Phone <br />Ten�nt� -- ; Mail Address Ciry Siate/Zip Phone <br />�y�f74C7' � 1CvrL- kJRK Mk=NT <br />/��i(S ,�%�`���-� G. �-.�'��C� LL- � 1�t,e���sn�r� w�4� q�� t-P Zd� ��? s�,6� <br />Electrical Contractor Mai� Addrass City Statelzip Phone <br />���SE� ��� �� <br />State License Number <br />��S - <br />Proposed Use of Building <br />13 z, � c�N�� 2c�� sQ �t" <br />Sqtaare Footage (If resid�ntial new construction, rerrtodel or addition) <br />C� <br />NumbEr of devices (If low voltage) <br />y� �'a �8d, a�r3 <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: ��- �r� ���"`"� `� ��- �� �_ � ��'�� <br />C1TY O� EVERETT LOCAL SA,�,�S TAX CO�E IS 3105 <br />1 hereby certify tha! l have read and examl»ed th;s appllcafion and know the sam� to b� true and <br />corraci. All pravisions of laws and onfinances goveming thFs type of work wil! 6e completed <br />whefher specifred herein or not_ The granlrng of a permit does not presume to give authorrty to <br />v;olate ar cancel the provisio»s of any oiher stafe or loca! !aw regulating construcfion or ihe <br />performance of consfruction. That ! am authorized by the owner of this prope,ty to perfarm fhe <br />work forwhich applic�fion is made and 1 camply with fhe Sfate Contraciors Law 1827 RCW and <br />296.20Q WAC- <br />W r� <br />REVISED .7/20�13 <br />� <br />FEE <br />�D'� <br />PERMIT# <br />� �_IOa` —�� <br />Ze ���d N��a �h�bz��zr� L9b20Z85Zb 6e �zZ bZBZ/aTlZO <br />