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ELECT�IICAL PERMII� AF'�ICATION <br />� � c' <br />PROJECT ADDRESS <br />t K �� <br />Owner <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERGTT, WA 98201 <br />425-257-8810 - �AX425-257-8857— u/w�.✓-��'-��Y•`����';D'/ <br />� <br />en,,..; I'. edere-F�FeQS (� �v�-r�t�' �:�r.r-..I.�'� � �D�--1 5 <br />`. <br />�iso�--el 6 <br />�-� M�>.nL r� <br />i � �i � i� � �?'` I <br />tAall Address <br />O�l p <br />..�u��i .,Jt�. �L 6;�;"•� 5. <br />Tenanl Mail Atltlress <br />C" bC1Lc� <br />Cily <br />City <br />l, o� �� �'` 'Z D � <br />State/Zip <br />SlatelZip <br />Phone <br />Phone <br />1 <br />��J���:�.'�c-�:�-cZ7t'-iC. �b Uo�C i�•�( I�iP-L�aw) b.��a, `I�i,'Cti`s �`IlS�ElZ-Zu�Z <br />6leclrical Contractrn tdail �ddress City S�aierzip Phone <br />, y <br />tl�.�.�b.;�� x 3�t� ��� �v �i <br />Slate License Number (required) Ciry of [verett Business License Number (required) <br />I�Gta(�nl+.C� <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If lowvoltage) <br />� <br />ti <br />Contracl Price of Work <br />� i � C'V.�S2i1n1 r;tc-nw9K�+2':xz v.��i�l�,� <br />Contact Person/Conlact NumbedCmail <br />De;cription of Work to Be Done: CGS���l1L/ ��`(��,�� 5-`lV iN c: I(,e���:���tY�f7�� ;i�= ����r17 S/ <br />f <br />`�,l !�'Tl-� (-I�� � S� (i(1 J'� l hi=�V) S Z� C�i �2�w I7'^c -- <br />CITY OF EVEKETT LOCAL SALES TAX COD[ IS 3105 <br />I hercby certily fhat I have r�ead and examined fhis application and know fhe same fo he true and <br />r.oriecL All provisions oll�ws and o�dinances governin� Ihis type ol work will be r.ompleted <br />whelher specilied hemin or noL Thc granting oI a permi( does nof p�esumc fo give authoiity lo <br />violate or cance/ fhe provisions of any ofher stafe orloca! low reyulafing const�ucfion or the <br />perlormance o/consfruclion. That I am au(hoiized by fhe oivne� o/ fhis property lo perlorrn (he <br />�vork fo� which application Is made and I comply wifh fhe S(afe Conf�uclors Law 7827 RCW antl <br />296.200 WAC. � <br />� ; <br />-- '��'���='� � �" � - -- - <br />si��aw�e � oa�c�_.— <br />� <br />RLVISED 00/OGQOi9 31 L(� _%�i ��l f� <br />F[F <br />�,�� bb <br />PFRMITJt <br />� I��J O \ � <br />