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EL�CTRICi4L PEFtMIT APPLIC�4TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257e8857 — www.everettwa.org <br />lv , O/,��r �ve- �i/, sk �7`�- /yb <br />PROJECT ADDRESS <br />�i-h.�u--.+-;, // �f.4se-- <br />Owner <br />( \ <br />Tenant <br />�/%/i���t ��P �"�"`� 9G✓Yra�b <br />Electrical Contract� <br />«� 68yo,�tP�f, <br />Mail Address <br />Mail Address <br />Mail Address <br />l�/�/il/ / ��� <br />State License Number (re w�ed) <br />/ GQ1 <br />Propo Use of Building <br />City <br />GJ1(�Ip VG <br />City <br />' N <br />City <br />Square Footage (If residential new construction, rer'nodel or addition) <br />�� <br />Number of devices (If low voltage) <br />� su,'f� z�-o, ��I`/ <br />State/Zip —� <br />State/Zip <br />� • 9�i ZS.��,S <br />State/Zip <br />Phone <br />Phone <br />Phone <br />.�z7�y� <br />City of Everett Business License Number (required) <br />< � 3.So - <br />Gontract Price of Work <br />Liea7�t uy � �r r� `^ i. G� <br />Contact Person/Contact Number Em 'I <br />z-�`3 - q3� - S / <br />�.�.� �61�-t. <br />Description of Workto Be Done: L,v� do/�fa9� �—�f ar ���!^o��✓��'`e- /�!�( l X,�_ <br />� <br />-�- s��►� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or loca/ law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� ` �7� L <br />�________?�� ���A.� ��-1�� ��j_'�' /L�/�7 <br />Date <br />REVISED 08/06/20�4 <br />FEE <br />C' <br />� �, �� <br />PERMIT# <br />E 15���� 1 � <br />