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V <br /> ELECTRICAL PERMIT APPLICATlON <br /> CITY t�F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E1/ERETT, WA 98201 <br /> 425 257-8810 - FAX 425-257-$857—www_everettwa.gov <br /> - �C�9 ���� �v� ��e�rT w,� ���aj <br /> PRO:IECT ADDRESS <br /> J�,v c.�i�tl,�rq�L ye�9 G�� A�u�, c-�r r �9 �j szo� <br /> Owner t�tait R;ddress Cily StatefLip Phone <br /> Tenant Mali Address City StatelZip Phone <br /> �vN�'L��� �G�.c��. G�C' 59�2 �z� SS7 Sc�' �,.,�u���,�` <��C..�, � �'�Y3 <br /> Electrical ContraCtor Mail Addr�s City &wlelzp Phone <br /> � Mau,�i�L_ 4�G� �S o536�3 � <br /> State License Number(required) Gity of E�erett Business License Nurrtber(required) <br /> ��SIa�N�. � �� �.� <br /> Proposed Use of Buiiding Contract Price of VVork <br /> �W��7 K�9��� yz.s'-563-�&�7� <br /> Square Footage(If residential new construction,remodel or addition) Contact Peraon/Contact Nu/m�beNEmail <br /> C�C1��+ fC�cs'�M�(/1� C�"f"I�o/�. CdM <br /> Number of devices((f tow voltage) <br /> Description of Work Eo Be Dona: /SV% t71$+'�S�� <-`'1kE� t�3 G°�,u�tJl� �,vQ/it2'` �`f ON� C��CC,� <br /> �Ot� r�.fL'!t-v�.�.VC /�/J (d,v� �l� G!�-Gvr! FC�- �1 d� Ovi L�r S. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � ���� ,� <br /> I hereby cerHfy thet!hav�read and examined thls applicafion and know tha same to 6e frua and � <br /> Corrack Al!provisions oF laws and orriinances govemlrig fhis type oI worfc will be completed <br /> whether specified herein or not. The granting of a permlt does not presume to give euthority to PERMIT# <br /> vio/ete or cancel fhe provisions of any other sfate or loca!faw regulating constructron or the y e` <br /> performance otconstruction_ That!am authorrzed by the ovmer of this property to perfomr fhe E �1 �5,.� j�j�^� <br /> work for which epplicaflon is made and!comply wifh the State Contractors Law t 8.27 RCW 8nd z.;- 6� ' <br /> 296.200 WAC. ' <br /> I <br /> dd 7 fs <br /> Signature Date <br />