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NO�J-15-2��4 09:59F FR�h1:PROFESSIONAL ELECTRI 360 4�5 1182 �0:4252578857 <br />• <br />EL.ECTRIC�4L PERNIIT' i41'PLICA`T�ON <br />CITY OF EVERETT PERMIT SER1/ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />3'� `��' �' ��� / / ✓� �. 'Z <br />PROJECT ADDRESS <br />P.2�2 <br />i <br />t/ fz ,- —, <br />1"t /� ��.s�t� Jt1_,_ �'/.� � �_r � ` -��� <br />/�' C'�—�� –,_T—f �C / f� Pr" J' � L C' ���! J� %��� � �e O.J _ C <br />Uwner Mail Address Ci1y , State/Zip Phon� I <br />V� <br />Tenant <br />�� <br />Mail Address <br />City <br />State/Zip Phune <br />� '� ' <br />� ^ ` �'J �v � r�L <br />./ �t�`��r.S� .i' . c��� / f�/c�c- J�, r. ..ff-� c ��� J__� �L%�7 1J'% �/..�o-> /�� L..�/-� % 1�%� �� <br />Eleclncal Contractor Mail Address City �ate/Zip Phone <br />� �� c�� � /: ..To 7 7 ��i <br />Staie License Number (required) � <br />C✓�� �P Siy �� �%�s✓/�ioi: J � <br />Proposed Use of F3uilding <br />Square Footage (If residential new cons�ruction, remodel or addilion) <br />Number of devices (If low voltage) <br />� -�-� � -� I --- <br />Cify o( Everell Business License Nu�nber (ieyu�reU) <br />�' __ � a_c v - - --- <br />Confract Pnce of Work <br />C/j ✓�= IE %�G r, J a.�7 <br />�J2s"= 33 0_��� u /'Jr�tC� �Pc �%/',•c �✓. <br />Contact Person/Contact Number/Email / <br />� aho� �Ir�'-� <br />Description of Work to Be Done: _(,��re. C v�-f�P �jo,� n e-, �.�, �/ � ryh �� � <br />.� G IP � I"M VH- T�+ <br />GITY OF EVERETT LOCAL SAL�S TAX CODE IS 3105 <br />l l�ereby cerfr(y thaf I have read and examined this application and know the same to be true and <br />correct, AlI provisions of laws and ordrnances goveming this type of work will be completed <br />whether specified herein or noL The granfiny of a permit does not presume (� give authority to <br />v�ulate or cance/ the provisrons of ai�y otherstote orlocal lew regu/ating cons(rucfion orthe <br />perlorm�nce of construction. That I am outhorized by lhe owner of this property to perfp�m the <br />work for which application is made and I comply with tlie State Contracto�s Law 18 27 RCW and <br />?96 200 WAC <br />/,�� / i . � , <br />ca <br />h�r nsen oaios�zoia <br />�. <br />�e <br />Ci <br />FEE <br />2 � 5 �� <br />PERMIT# <br />E�y12'U�� <br />