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ELEC�ICAL PERMIT APF-LICATION <br />� � <br />PROJECT ADDRESS <br />� Ff F'1 <br />Ovmer <br />Tenant <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, 1�lA 98201 <br />425-257-8810 - FAX 425-257•8857 —�a' c,� w' _� ;�G��' ; w2 � J�J ✓ <br />�k.,ti� (' L'Jc:r��-�itQS `J L'V[:.:'L�'! W:'L �j,�.� . <br />.J <br />r�, <br />1'o tj�;c 1 �j��') <br />Wail Atldtess <br />C,�.,,�,� � t r u.; i<1; �r- <br />���lC,'�l:l:�{'- �,��L'T�� iL <br />htall Apdress <br />FL �',o � `I � t <br />[ti�,_.:�7- � ;. <br />CA}' <br />City <br />�� t'-ff-�,.�.�.,) L..i4 <br />`/iZt�l <br />S�ate/Zip <br />SIaIMZip <br />�� �,�`,y <br />Phen� <br />P7orc <br />ls)�l2 2c12. <br />• ElectGcalContra[tor t:talli.Cdress Cdy Sta1e/Zip phone <br />I � <br />��',, . �p.;,. e.r_ 3�� � t,� � o� i: i y <br />iSlate License Number (required) City of Everett Business License Number (reqwred) <br />' �;�,00 <br />I E�G�. ^�(Yli.lvi5 � <br />� Proposed Use of Building ConiraCl Pric- or Werk <br />Square Footage Qf re,idential new tonstrucfion, remodel or addition) <br />e.�w� <br />Number of devices Qf low voltage) <br />TS C"L�4iC�n1 Tsc -YNc.q.;wr �L ,v,.� ���-:, � <br />Con,act PersoNConlar.� ;Jumber/Email <br />Description ol Work �o Be Dene: CCS��',�1-iL� (��i�(.y 5'�V iN l ��-�°a'�c,.•';•��f7�•�j- C�= li(„-�7'S � <br />`tbn'ni 1-l���� � 141vu1' fl_�)1. C� Gir2ati��TS _ <br />CITY OF EVERETT LOCAL SALES 7AX CODE i5 9105 <br />� herrby certily fhaf ! have read and exammed this appficafion and know the same fo Ge frue and <br />conect. Aq provisions o(larvs and ordrnance; goveming fhis type ol work iviH be cwnplefed <br />wne!her speciGed hemin or noL The gran(ing ol a permif does not presume to give aufhonty to <br />wolate or cancef fhe provisrons of any other sta(e or local laiv �egblafing conslruc(ion or the <br />p:Aormance ol consfruction. Thaf ! am authoiized by the ownei ol this propeRy to perform the <br />ivork /or which application is made and I compty �vrth the Stafe Contractors Law 78.27 RCW and <br />296200 4VAC. <br />, �•�'1 ! ,�1 �� �r�,— �/ <br />Signature � <br />i <br />_ev�s:uca^esou �jl L� 70 L i'f <br />FEE <br />T ��0�� <br />PERh1fi;? <br />E i 50� -1�� <br />