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ELECTRICAL PERMIT A�y'PLICATfO(� <br />C� � <br />PROJECT ADDRESS <br />�kti� <br />CITY OF EVERETT PERMIT SEkVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — u/ w uJ -E �'u'y-f` W2 <br />� n.� : f•. L�ere-+-{e ps � evr�,��t.f t��.-.q oJ <br />J <br />�! S�O --1 S6 <br />/0- ar-� s <br />Li N n� <br />i'� �`i�F � �J�I � <br />Omter tdzii Address <br />G1w�NpJ�Ew l�ir i 5. <br />Tenant Mall �ddress <br />f'V1�vl..�f �I.cZ�1Z�G �0 UoF `i,°��� <br />Elec�ricalContrector �dailAddress City <br />��•- �pu�E i 3�� ��i <br />State License Number (required) <br />�vr�r�m�,�ts <br />Proposed Use of Building <br />Square Footage Qf residential new conslruction, remodel or addition) <br />Number of devices (If low vollage) <br />J�J � <br />j,J,� �( �'' ZO � <br />Slalc2ip <br />StateZp <br />1tin <br />��v-ciy <br />�I�D�'s <br />Statc2ip <br />Phone <br />Phone <br />2-Ze�2 <br />Phone <br />City ol Everek Business License Number (required) <br />� •Z�D,�% <br />Contract Pnce of Work <br />TS G'uiL�^rtlnl TSc-Yxo9a�rt.��v..iuNk�t <br />Contact Per�or✓CoMad Numbcrl�mail <br />DcscriptionofWork�oBeDanc: ��•5�"�� ('?"�'�{,�y S�i'�irf� t�-�°u�t�'1ti�('7�j- G� ��G�+T-S � - <br />7�A'iN FnNS � R11tiUE K-'�)S� Z Gt/L��,� 1 S <br />CIIY OF EVERETT LOCAL SALF.S TN( CODE IS 9105 <br />I hereby certily Uiot I have mad and examir,ed Ihis applicatlon and kno�v the s.=.me to be fn�e ord <br />coirt;cL AIi pr�visions oIlaws and oidinances goveming this type oI work �sil! be cnmplet�d <br />�vhefherspecified hemin or noL Thc granfing o/a pe�mif does not presume to yive authonty !o <br />violate or can:el (he provislons olany ofher state or locallaw �egu/ating consWcfion or fhe <br />pedormance o!consWcfion. That I am aufhonzed by the owner o( this property fo peAonn the <br />�vork (ar which .�pplicafion is made and 1 comply with fhe State Conl2ctors Lew 18.27 RCW and <br />296.20D N/AC. � <br />r,et��s:nonc::ro,< �jI�LC. �iL� [=. ('}-/-� <br />FEE ��k'�p b� <br />P[RP1IT# <br />E151D��5fo <br />