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m <br />ELECTRI�AL PERlUIIT A�PLIC�4TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�GIO S �`V�Cr�h2Q c� �� ��2�70 <br />PROJECT ADDRESS <br />Wj�hc�S� ��-� ,� 2�� Sa � ti � 1��7t w� ��� a� <br />Owner Mail Address City State/Zip Phone <br />s��"� <br />Tenant <br />�CV � S <br />Electrical Contract r <br />SGi cn-� L <br />Mail Address City <br />����. S ;rs �� s �`��� � �� so � <br />Mail Address City <br />�� �Z`/ S S �s S 3 '�`� � <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />�. �� o �z � p ( 3 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />�� �� � w� <br />Phone <br />State/Zip �2� �� � P�o�� <br />����'�f� <br />City of Everett Business License Number (required) <br />ZJ (J � <br />Contract Price of Work <br />3r�.r� J�-��a�s <br />Contact Person/Contact Number/Email <br />) ��1 � �� ��t-��-I �,5 h �� �, � � <br />l hereby certify that I have read and examined fhis 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 local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />�� � ��� <br />iat re F <br />REVISED 08/06/2014 <br />FEE � <br />✓ V <br />PERMIT# <br />E 15�'�- IZ <br />