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ELEC�ICAL PERMI`T AP• IG/�TION <br />v'—j `-1 <br />PROJECT ADDRESS <br />t I� IA <br />Owner <br />G���;:, ���, �, � �� c<� <br />Tenanl <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —��i w+.rJ.� ���-��`�'T i�wt . 3.J ;% <br />e��•.a� 1• �uc!re-I�ieps � ev�r�tf ,;:�:z-��� <br />� <br />�—IS <br />�.� � h �,.� � <br />i'o t�:� I h�i 7 <br />Iv7all Atldress <br />M11ail P.UtlrCsS <br />c ��,L�-,-r <br />Cify <br />Clly <br />�—a <br />� iSoB-16� <br />.�J�. �� �G LJ I <br />Sfale/Zip <br />Slatc/Zip <br />Phar.e <br />Phonc <br />���1i3O�'�1.:\; ��,�;(.'f1�1C. i6 I','JF `��t �iP-lLUra��� ' �'4,t G'- , <br />� � L.�i1. I..J:s i`Ili%�l2 2ciL. <br />Elecidcal Contractor Mall Address City Sloir.;�fN Phone <br />���� �����c r_ 3�'� '�,1 ��2� �� y <br />Slate License Num6er (reyuired) - City of Everet� Business Llcense Number (required) <br />I�CI�,^�:Tt? i.��S <br />Proposed Use of Bullding <br />Square Footage Q( residenlial new con,lruclion, remodel or addition) <br />Number af devices Qf low voltage) <br />� <br />Contract Frice of Work <br />��S C"tn4.R-I1N r;Sc-Iw+�•;w2�e? n,,.iuHv.�4�. <br />Contact Person/Conlact NumberlEmail <br />Description of Work Io Be Done: ��'�"�1�� (��"�T�(,'y S�q'J ii� � f(,cl �������1��(7�j- .�= ����G; il"c; � <br />`�A"T"Li (1NS � I'ul:��,;,F. Fi.�qS / . rio,. .-r-c� <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />1 hercby certlly (hat 1 have read and examined fhis applicalion and kno�v the ;ame to be true and <br />correcL All piovfsiorrs o( laws ond ordinances yoverniirg (h�s type ol work viill be complefed <br />irhether specilied heiein or no[ The �ianling o/ a pe�mit docs nof presmne to give au(hority (o <br />violate or cance/ the piovlsions o( any oUier sta(e orlocal law regulvting consfruction or (he <br />poAormance ol conshucfron. Tha� I'dm aulhoiized by the o:vner o/ lhis propeRy to pcilorm fhe <br />tvoik lor �a�hich opplicatlon is made and i comply with tfre Sfafe Confractors Law i8.27 RCW and <br />296.200 WAC. <br />� <br />; i� � r <br />�� -;11,�.. : <br />Signa(ure ; 1 <br />J <br />acvucu oaroar.ora 1 L C_ 7L) [- �`( <br />- ----- -- -- ---�— -- <br />FEE � <br />�1�)f/.�✓ <br />�Efzr�rrro ==--1 <br />E I��� ll�`l-, <br />