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ELEC�ICAL PERMIT AP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVER[TT, WA 98201 <br />425-257-8810 - Ff1X 425-257-8857 - W i.a i�J -c �'�r.� � = :��: . �r'"+ :% <br />c;�,•., , I. E������+eos G� cv�-�-zr,' �:�U- J.�J <br />� <br />�-� S',0 —07�7 <br />�� � �> �� �:� ST <br />PROJECT ADDRESS �O�-� —�S� <br />Otvner <br />Tenani <br />��P�+ ro,;,;� i ti-�� <br />Mail Address <br />GiG41�1)���t Vv ��1Y�1 <br />�dall Address <br />1 , <br />I''Ulc��',u�;= ��2�'-�L (•� i•�,� y°.L <br />� �r�c.:-rr �.�a, <br />Cily <br />Clty <br />�t I�lLt�r���) 1,�q <br />�/ Q• L8 � <br />Stale/Zlp <br />State�Z�p <br />`I �� D �� y <br />Phonc <br />P�ane <br />lZ�2c�� <br />Eleclrical Contractor tdail.4ddres, Ciry State/Zip Phone <br />jr:� . cp.� � f 7 3 t"� i.� f �'2i� l•, I�j <br />S�ate License Number (required) City of Evere�t Business License Number (r��qw:ed) <br />��c�ar��,tiz.r,.r �� Z`�p °% <br />Proposed Use of Building Contract Pric= of Work <br />Square Footage Qf msidentiai nevi consUuction, re�nodel or addilion) <br />� <br />Number of devices Q( lov� voltage) <br />TS C"LuS��I1N r;Sc-nu9Kw2�.,v,.,���u.: <br />Conlaci Person/Contacl NumbedEmail <br />Descriplion ot Wnrk �o Be Done: CCSMe�'�L/ (.�.,��� � }.qv,N � i�,�_�'H.iLtlry�t7�j- ��� t�6, �� S� <br />E <br />���n� �=r��> � iw�.��c r�.�,�s �:' c'tf.:r�.r;,�� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hemby ceRily thaf I have read and examrned this applicatron and kno�v the same to be true and <br />coirecf. FlII provisions o/ laws and ordinances goveming this type ol roork o-vill be comp/eted <br />ivhether specilied herein or noL The g�anfing ol a permif does not presume (o give aufhonty to <br />vio/a;e or cancel fhe p�ovisions ol any ofher s(ate orloca! law regulating construction or fhe <br />perlomiance oI consVucfron. That I am oufhonzed by (he o�vner oI fhis property ro pedorm the <br />n-ork /or u•hich appliwf/on is made and I cornply with (he Stafe Confracfors Law 18.27 RCW und <br />?96 200 INAC. <br />REVISED 0lNNIOIa <br />r-�E <br />�� D <br />PER�dii:, <br />E �51p-�'15 <br />