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ELECI�ICAL PERMIT AP�LIGATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />47_5-257-8810 - FAX 425-257-8857 — W tv+.�J -C ✓%��-;'-:' �•_ . �•t,� :: <br />� I'. �. F-� s�� �•, � „ " <br />e��,,., t�c-.e- e� � Ei��Lf-, Ul:z J�l <br />6 �ab-�s <br />� �� ,,� �, � T E� 5a 6--r � 5 <br />PROJECT ADDRESS <br />t��� i o'ri % ! F7`I _% C �[1Lr'1"� j,._ P� �� �. Z�� ( <br />Owner Mail Address Ci1y Slate/Zip Phonc <br />GI4-11��) �%! CU.: U�� �'Y j. <br />Tenant tdail Address <br />City <br />Slale/Zip <br />Phone <br />Yv�b�v U�� �L�Z'n� i[. (�b !�o X y°6� LC� i'-(�-v,a,.,� LJq.. `j ��(1 �'� 3 � <br />�IL�)S'lZ�2c�"L. <br />Electrical Contiactor Mail Addross Gry StalelZip Phone <br />i <br />�,!.;.D.��r i ?j�� v-j �z',��`I <br />Slate License Numbcr (required) Cily of Everet� Business License Number (required) <br />n �i3;1 ��!" `'� <br />i�J���i l�l.�i l� <br />Proposed Use ot BuilAing Contract Price o( Work <br />Square Footage Qf residenhal new consttucfion, remodel or addilion) <br />�r <br />NumLer of devices Qf low voltage) <br />� I � C'"L++T.�ZIlh1 T,Tc-hMu9.;w2'c? ��..:�i,+v,l <br />Coniact Person/Contact NumhedEmail <br />Descriptlon ot Work to �e Done: C(',S�ti�l1G L��"c�(,'r $�iV IN l i� c1 �U �l.tV��t7��- ��}= l.IirlYe <br />J <br />�t.+��,z� r-nNs � i�r,ti�e K-�'�)5 _ Z �r.r�tA�� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I heieby certily fhat 1 have read and examMed fhis applica(ion and know Bre same to be true and <br />correcf. /111 provision� ollaws and ordinanr.es goveming fhis typr, o/ woik r�ill be canple(ed <br />�;hcther specilied hereln or noL 1 he grantiny ol a pennil doe; nof presumc to yive au(hority to <br />v�olote or cancr./ fhe provlslons o/ any othcr stafe orlocallaw iegulaling construr.tion or fhe <br />peilormancr. o/con;trucfia�. Thaf I am �uUiorized by the o�vnerollhis property (o paform the <br />�voik lor which application is made and I compty aafh Ihe Sf�(e Con(rar.tors Law 18.27 RCW and <br />296. Z00 WAC. <br />r,� ; <br />, <br />— - �'Lc�- ;,,- �— <br />Signalme � ------ <br />1 <br />���Ilh'I y __ <br />O;tll` -- <br />nevisrnue�ocrzoi�; j;y/�LL� 7b �-=({� <br />F[f= <br />�5���� <br />PERMIT/t <br />E � 5o(n — j�15 <br />