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ELEC�ICAL PERMIT AP�LICATION <br />CVTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — w' c•r �+J -� ;'r'—rLf; :�t�:. t•�; ✓ <br />� <br />�Ir.� � i�. gV�re�"�eOS � GV�rGf� ':aJJ�- ?,+.r . <br />`�� � _ �6�� <br />�GS luc.L�s� �isa6—�q� <br />PROJECT ADDRESS <br />{:�M1 i'o i;ij: I �>`I� <br />Owner 61ai1 Atltlress <br />� <br />..�i81N��4�t�: V.1 ���! 1 y. <br />TenaN t.tail �ddress <br />E�n�?�r� <br />Ciry <br />City <br />� ` `, <br />L��: ( ti I <br />Slate/Zip <br />State�Zlp <br />Phone <br />Phone <br />I/�t"�� ��/ (, <br />U:�U�,:1i� ��L,'�.Tfl''-I(i �� i:'JJ( `���r V�-ll'�i�l.0.L.i� itii�. ��L'��L�S �� �I� <br />�`�ZS �ZZ'Z(. � <br />Elec(rical Contractor hlail Address Cily StatelZip Phone <br />��''��� ��N�t Z�� L l.lr � L1 L• I`i <br />S�ate License Number (required) City of Everett Business License Number (required) <br />(�Gra�s'���.,=�� �, <br />Proposed Use o( Building Contrac� Price of Work <br />Square Footage Qf tesidential new conslruction, remodel o� addition) <br />�r <br />IJumber of devices Qf low voltage) <br />TS C"1n±C�2�h1 T,tc-Ixo9•�u;.�i�.�vw�i�u�4: <br />Contacl PersonlConlact NumbedEmail <br />Descriplion of Wurk lo Be Done: ���;��`� 1�1L! (��Cj;"�(,'y S�1V i N � iLilnu���LdYL�[7�{- �= L�Cr�-�'4 � <br />F <br />`jl /�'ll�-, �-I��^� �� Iif1ti:�F.' F��c� j _ Z- L� /-'��-+-1 � � i -- -- — <br />F[E <br />CITY OF EVEREiT LOCAL SAL[S TAX CODE I5 3105 �(�O 6O <br />J J <br />I hcreby certily thaf I have read and examined tbis applica�inn and kno�v fhe same lo be true anU <br />co�recL All prvvisia�s o/ laws and ordin, nce�s goveming lhis type ol work �vilf be compleled � -- <br />�vhether specilied herein or no(. The gran(ing o(a pe�mit docs not presumc (o give auUroiiry to p[Rh7IT;t <br />violafe orcancel the provi;ion; n( any other sfa(e orlocal lav� regulating construcfion or fhe ��� D� J I� �� <br />per/ormance o(cons(ruc(ion. ina7l am au(honzed Uy fhe owner ol this propeity to pei/orm fbe <br />n�oik lor �vhlch ripplica(ion is m��de and l compty wit7r lhe Sfafe ConUac(ors Law 78.27 RCW anrl <br />296.200 WFlC. — <br />� <br />_ r,�L'l �� k;�.-'% D(, I I I)� I S <br />—s�gna�ur� - o�tle -- <br />�J <br />HCVISCD 09/04201a ' � " � ( � � ��� /,C �..1 � . . <br />C� 1 <br />