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EL�C�ICAL PERMaT AF�LIC��iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CFDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — �vNrva.evereitwa.org <br />Zl� l,:.c.�,,sz <br />PROJECT ADDRESS <br />t�'.4 i o 5::j� I h'-I� <br />Gwner tJail Addreu <br />Gil;�1Ni;ViEW' G'`��"i`�. <br />Tenanl hlail Address <br />l�lcD�-u�� ��c2���c: P� »x yg <br />ElectricalContractor ntailtidtlress <br />lr%� cp.��e z 3i)'� ��i <br />Slate License Number (required) <br />;� Gta ��;; �i,k�� i � <br />Proposed Use of Building <br />E vC1L� 1"� <br />C�ry <br />Cily <br />I�t I'-+f-��a�-'� <br />City <br />Square Footage Q( residential ner� construction, remodel or addition) <br />Number of devices (If low voltage) <br />L=l 5��—O�� <br />('�— fS—/ S <br />� c <br />�..:v� � �� G�J � <br />S(alelZip <br />State/Zip <br />1ti%u . `I �i,� D ��� 3 <br />StalelZip <br />Phone <br />Phone <br />�lZ�lu�2. <br />Phon_ <br />Uii l: I `I <br />Ciry of Everett Business License Num6er Qequred) <br />F <br />Contraci Price of Work <br />�TS C`V.,S,(��nJ TS'c-nw9.;i:.+'�,� �v..:���;�,� <br />Contact PersonlCont2ct NumbedEmail <br />Description of Work to Be Done: CCS�K� 1-jL (��i �{, % 5%��� � r� � �Le���.�x.�1'tiC�W- 6� ������ �- i <br />y,li\•n-i i;'\;•+S � I'vl:suC rl-tiS � (.�r.u�i� <br />� <br />CITY OF EVERETT LOCAL SALES TAX GODE IS 3105 <br />1 be�eby certi/y that 1 have read and examined this application and kno:v the same l0 6e true and <br />correct. All provisions ot/a�vs and ordinances goveming fhis lype ol �voik ivill be ronrplefed <br />r�helher speciiied he�ein or noG The granting oI a pe�md does not presume fo give authority lo <br />viola(e or cancel fhe provisions olany other stafe or loca/ law iegula(ing consVuction or fhe <br />peAormance of consfruction. That 1 am aulhorizeU by fhe oivner of this propeRy fo peAorm the <br />n�ork !or �vhich applrcation is made and I comply wi(h fhe State Contracfors Law 18.27 RCW and <br />296.200 VUAC. <br />06 <br />,revise�os:osrzc,a � r C L r0 L=l-l� i <br />FEE <br />� I✓��% <br />P[RhilTi: <br />E I 5b�- 0�� <br />