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Jun. 15, 2015 11 ; 03AM <br />No, 9481 P, 2 <br />ELECTRIC�L pERMIT APPLICA7`ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�25-257-8610 - FAX 425-257-8857 — www.everetiwa.org <br />Z�l � �(,�-9�e,r � <br />PROJECT ADDRESS <br />Owner <br />Meil Address <br />Ciry <br />�o_c'� 7 l0 U' /� { J <br />StatelZlp Phone <br />Ten�nt Mail Address City State/Zlp Phone <br />n'�,, r,- u2� � <br />�l—�oi^e�h.5l �i��i)cj r'�llQ��� ��/ - ��� Q_� Ti (� �c�C� � Z�Z-U. <br />Electrical Contractor nna�i aadress City StaielZlp Phone <br />(�St-1 � hSK�i301°-1�- <br />5tate License Numbor (roquired) <br />4�-� � �( �C11.�� � <br />Proposed Use of Building <br />��oo <br />Square Fo�tage (If residential new consfruction remodel or addition) <br />Number oF devices (If !ow voltage) <br />Description oF Work to Be Done� <br />CITY OF EVERETT LOCAL SAL�S TAX CODE IS 3105 <br />O� LW�� <br />Gity of Everett Business Lice��se Number (required) <br />�i000-0� <br />Confract Prlce of Work <br />� rQ � C� U�I,�n o�`, v� r(' �s�✓� <br />Contact Person�ontact Numbe Email <br />I heredy certify that l have rsad and examined fhis applicaGon and know the same to be iruo and <br />correct. A!I provisrons oflaws and ordinances govoming this type of work wi/l be complefed <br />wi�ether specified hororn ornot. 7'he granting of a permit does nof presUn�e to give �uihority to <br />violate or cancel fhe provisions ot any ofher sfata orloca/ law regulatrng consiructron or (hs <br />performance of conslruction_ rhat I am authorized by fhe owner of this proporfy to perform the <br />work for wh/ch applicaliorl is made and I comply with the State Contraclors Law >9.27 RCW and <br />296.200 WAC. _ <br />rg <br />FEV/S�D 03�Ori2094 <br />.... . f� I i�"ll S <br />FEE <br />�� ��' <br />� <br />PERMIT#� <br />E�,� � ��;�, c��5 <br />� <br />