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ELECT�CAL PERMIT �1P�ICATION <br />� �M� <br />PROJECT ADDRESS <br />{; I� 1.1 <br />Owner <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — ul t.•r t.+J -t ��t.rr� "�' :�/,� - c�,) ;i <br />�s <br />�it,� � I'. eJ�re�-f��s � e✓tr�t'=�f' 'ulEz.-�J <br />.� �l_Da-as l <br />�1.�-82-� <br />l�� r��Fr..1 <br />i � ig:� I h'-�% <br />hlail Address <br />Ciw�N+'Ji�i 6�; (;;};^j� <br />TenaN t�tail Adtlress <br />C V�1Lc"lr �Jp� <br />Ciiy <br />City <br />��Llc'�V.t,:�f? l.�CZ'il�iC., ��C .,SX ��r.l �il'-r�-i���� <br />Eleclrical Con�rdclor Mail Address Cily <br />I�'%� cb;;�r r 3�`� i�-( <br />State License Number (required) <br />IJ Y �V {✓I '�I�: �v t' <br />Proposed Use ot Building <br />Squarr. Foolage Qf residential new construction, remodel or addilion) <br />Number of devices Qf low vollage) <br />�.) <br />�'i� i; � `I <br />���.ZJ� <br />Sta�e/Zip <br />Slale2ip <br />"IiiDE`3 <br />SIa�e/Zip <br />Phone <br />Phone <br />�� )8"lZ Zo�2 <br />Phone <br />Ciry o( Everett Busines; License Number �required) <br />y!_. . <br />4 <br />Contract Price of Work <br />��SC"'L�+S�Zll�•l �Sc-Y�w9�u2�i2�v.,i�i,�v.,t <br />Conlact PersoNContact NumbedEmail <br />Ue;cription oI Work lo �e Done: CGS���l1( / L-Ti�,j,'y SAV Ir�L i�,�l"v.�[.tl'�8'rv-j- O� �����T'S. � <br />f <br />_ yLA'I�.1 (-�'�i�S � illl.vul� hi.�)S �t� Lt2r,���7—> <br />a <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />l he�eby certily that I have read and examined tlris applicafion and know fhe same to be true and <br />couecf All provisions ol laws and ordinances govemin9 fhis type ol work vdill be completed <br />whefher specilied hcrein o� noL The g�anting ol a penni( does not presume (0 9/ve aufhoiity to <br />violate or cancel the piovlsions of any other slafe or local law regula(rng cons(ruction or (he <br />pedormance o! con;fiuctian. That I am mdhorizetl by the o�vne� ol fhis pioperty to pe�iorm fhe <br />work Io� �vhich applica(ion is made and I compty �rith flre Sta(c Contrac(ors Law 18.27 RCW and <br />296.200 W/�C. <br />ircvacnuuiocaoii (-LL 7l) � �`f'%i <br />�-------------...--- � .__-- ---- -- <br />f=[[ <br />� 5t�, °= <br />PERI�1IT�l <br />E �I�l�- �2(� <br />