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� <br />� <br />ELECTRICAL PERMIT APPLICATION <br />� �� ��us� <br />PROJECT ADDRESS <br />t �' �t1 <br />Ocmer <br />C��a�.,nU:Fw li�. <br />Tenant <br />CITY OF EVERE7T PERMIT SERWICES <br />3200 CEDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857—�vww.evereth�da.org <br />i o �5�i� I �j'-I � <br />Mail Address <br />hlail Address <br />E vr'lZ.-'lT <br />City <br />City <br />� _�o-/s <br />� �so6--�s z <br />��6� I �i ZD � <br />Sfate/Zip <br />State/Zip <br />Phone <br />Phone <br />� jn�.%�J�-�;�� �I,cZi(�iL. Q6 ��ajc i��l �i1=��N� LJn, `��iJC$3 � <br />� l l> ) S'LZ Zu � 2 <br />� EI=_ctrical Contractor �nallAddress Ciry StalclZip Phonc <br />Ir��'-cpu�e i 3v'ci 1,�1 <br />S�ate License Number (required) <br />� i'.IYI�i�'1, Y�.rN IS <br />, Proposed Use of Building <br />Square Pootaoe (If residential new construclion, remodel or addition) <br />Number of devices Q( low voltage) <br />� 2�- (: i �j <br />City ot Everelt Business License Number (required) <br />� <br />Con(ract Price of Work <br />TS G"�v✓d.(�-t�iJ T;Sc-Yho9.;w;^���vw�i�k,� <br />Contac� Person/Contact NumbedEmail <br />Description of Work to Be Done: �L'S�k� }1L i���C�°'�j,' S-9V i r� � � r-Y^uo��l,u�i'7��- �i� L�(„-ITS � <br />�+�T� FnNS � P.,�:,;G� 1w�)S , .3 42w�rs <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I he�eby certily that I ha�.e read and examined this applicafion and knom the same fo be true and <br />correct. All provisions o/:a�vs and ordinances goveming fhis type of �vork �vill be complefed <br />ivhether speci�ed herein or noL The gianting ol a pennif does not presume to give authority to <br />viola(e or cancel the provisions ol any ofher sfate o� loca! law �egulating construction or the <br />perlormance olcons(ruclion. That I am aufhorrzed by the oivner oI this property to perlorm fhe <br />r�ork lor which application is made and l comply with the Slate ConUactors Law 18.27 RC W and <br />296.200 WAC. <br />� <br />Signa'. <br />� FE4'lSf00P:Cdn01J <br />�— — — <br />— <br />�G <br />� L L 71� L �'+A <br />FE[ <br />--7 5 0 a --J <br />1 <br />P[RMIT# <br />E 150�-OS? <br />