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play 15 2015 329PM HP Fan <br />Pane 1 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetwa.org <br />M <br />PROJECT ADDRESS <br />4z <br />SarsHfa rr1G- t3107 /41 oR s muL'JiM LA/A- V012-- <br />Owner Mal Add rasa City StatelLp Pions <br />5,'ke t a c'-t r5 <br />Tenant Mall Address City State2lp Phole <br />f.szy 13^ Lrj /Jf_ 7kob-33$?A <br />I1t¢ tJl- EtfcTr�fG It c_ �#0 Kttie"-Ilo L✓h- Wt7jy' <br />Elecbical Contractor real' Address Cty <br />State License Number (required) <br />S <br />Prcposed Use of Building _ <br />Square Footage (If residential new construction, remodol or add 0cn) <br />Number of devices (If low voltage) <br />State2'p <br />Phone <br />City of <br />Everett Business License Number (required) <br />tD coo -n O <br />Contract Price of Work <br />/ II wifRh✓rFco. <br />cpfetJ 6vfe-" 406 -33S-895<0 <br />Contact Poison/Contact Number/Emall <br />Description of Work to Be Done efn►OD[L SVA-e-£ kit 5ta Pfe?CU %S {/,¢!,L &4 7— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />1 horeby eorbfy that I have road and examined this application and know the same to be true and <br />eorrocf. All provis/ons of laws and oidinuneas governing this type of work will be completed <br />wtWhorspeGfiod heroin or not. Pro granting of a permit does not pmsuma to give authority to <br />Volnfe or cancof the provisions of any other state or local law regulating constructor, or the <br />performance of canstnrclion. That I am nuthorizod by the owner of this property to perform the <br />work for which upp/lcatiun is made and f compty wdh the Stale Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Slar,alire Date <br />1`117VIsaooa W14 <br />FEE <br />Z ZO �o <br />PERMIT# <br />E 1505- 09 <br />