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�L�C�ICAL �'��tfUll� A�LICAa�i(�N <br />CITY OF EVERETT PERM17" SERVIC�S <br />3200 CEDAR STREFT, EVERETT, N/A 98201 <br />425-257-8810 - FAX 425-257-8857 – wvNd.everethNB.Ofn <br />��7_�1 ;,d��,-, � <br />PROJ[CT ADDRESS <br />t��A i'o 9�jc I i'`I�% <br />Ot:�ner Aqail Address <br />Gi4�1Ni)Vi�W' �i��r i�j, <br />Tenanl 1�tail Adtlress <br />I���J� � j� <br />lUlcl�L'.L:\i `I.CL11�1%� Pr� ,ar y�f. <br />L Vtl(,.--Tr <br />C�ry <br />City <br />�1 I��'�IJ� <br />ElectricalConiraCtor MailAddress City <br />��°' �����t �- 3�"6 ��"1 <br />State License Number (required) <br />':1 P)� ��ti.c �� <br />Proposed Use of Buiiding <br />Square Footage (If residential nes+consirucfion, remcdel or addition) <br />� <br />�Jumber of devices Qf ;ow voltage) <br />(�-15 '/� � <br />C ISO(��7 S <br />L�%G> <br />c�� Gi)� <br />SIa1cILp <br />Sfate2ip <br />wn. �I L�D�'J <br />S�ale/2ip <br />��i;i� <br />Pnone <br />Pdcne <br />�"l2 loi"L <br />Phone <br />City of Everett Business License Num6er (required) <br />P� <br />i.� <br />Contract Price o( Work <br />TS C<us��nN rs�-;,,u�.;�,;.iv ,��,��Nu,c;•�,n <br />Contact Person/Contact NumbedEmail <br />�escription of Work to Be Done: ���•S��`�11GI (��i�,�j, � S�3V i N � ��,�j'o:aL�V�iE7w- ��r Ld(�1T',� � <br />�f�'1Z-i (1r�S � 1�1vG1 ii=ti)> - � �—{f2��ll� <br />CITY OF EVERETT LOCAL SALFS TAX CODE IS 3105 <br />I hereby certily that l have iead and exarnined this applicabon and kno:v (he same !o Ge frue and <br />correcL All provisions o(/aivs and ordinanres goveming this type oltvork iv!//6e comp/eted <br />whethe� specilied he�ain or noG The gianting of a peimr( does nol presurne l0 9ive authoiity (o <br />viola(e orcance/ the p�ovisions o/any othe� sfate o�local law �eguloting construction or fhe <br />pe�formance o(consfruction. That I am authonzed by the owner o/this p�operty fo perform the <br />�vork lor �ahich application is made and l comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />REVISE0049G'�oN � l L � %Z� �� ��' <br />FF[ <br />� -� 5, o0 <br />f'ERh1ITt� <br />� � �JD(o"��1 S� <br />