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ELECTRICAL PERI�JIIIT APPLICATION <br />4�ur,1 <br />v I �� <br />PROJECT ADDRESS <br />Owner <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857- �.✓tvuJ-e����c?'��:��.a.•v�� <br />C lu�x.� I'. LV��c�#-Fe DS @ cV��zt-� :cld- �}d ✓ , y <br />`' . -7��.r> �1S <br />�. , <br />L� � 7; E- � s�7 a� � <br />� ° �5`Y ( "�`t% C�tl2� tr ° � <br />�-?2, � � L � <br />Mail Address �;�y <br />Cfw1N�)�i�lA% �:IY{�5. <br />Tenant �nali Address <br />Clty <br />State/Zip <br />Stale2ip <br />Phone <br />Phone <br />('uIC�V.I,r�i �I,GZ�121L �C• iJJX i��� �ll°—ILI.v��.,� 4.�4, ��L'�ti'S �y7.)'��2Z•Ze�?. <br />Electri�^alContractor IJ�allAddress Cily Slate2ip Fhone <br />}Il��.��,�,, r� 3�� ��j �z- c, y <br />State Llcense Num6er (requimd) Ciry of Everett Busineas License Number (required) <br />�'JOl�i�ti(111ki�115 �` /� Op �j <br />Piopused Use ot Building Conlrac� Prlce of Work <br />Square Poctage (If residen�lal new construction, iemodel or addi(�on) <br />Number ol devices (II low vollage) <br />Descrlption o1 Wvrk lo De Done: CCS�'`�l-1L <br />TS �'"ln±L2�1 nl 'i'Sc'FN�c9�w+2�xi �vw�iNu 4 <br />Contact PersoNContact Numhed6mail <br />SAv;N� <br />�;Gr�rc„ <br />^ — <br />_ ��a•na r-n � s � iu,.� �� r����� s �_�, ��-��, � r•, <br />CITY OF EVERETf LOCAL SALES 7AX CODE IS �105 <br />1 hereby certi/y fhaf / have read and exomined fhis applicaflon antl know fhr, same fo be buo and <br />cormcf. ANprovisions o/faws and ordinances govem�nglhis fype of work will be comple(ed <br />whefher specilied hoioin or not. The gianling o/ a pemiil does no( pmsume fo give auUiority ta <br />vivlafe or cancel ihe provMlons o/any other;�ate orloca! lawregulaling consf�uction o� U�e <br />peNormance of consbucflon. That l am au7horleed by fhe nvinerof fhls propeRy to pcAorm the <br />work for wh/ch applicaflon Is made and I compfy ia�i(h 1hc Statc Confracfors Law 18.27 RCW and <br />296200 lh�A C. <br />OG <br />��w�ro�so��oi. _� � LC. 77� [� (-t <br />FEE <br />�SD, � <br />P[RMIT;F <br />E 15b�1-21Q� <br />