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1'roni� 01/22/2015 14'09 ��030 P 003/003 <br /> • � <br /> ELECTRICAL PERM17 APPLICATIC��I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-25'-8857 -www.everettwa.org <br /> CY 5a���zo <br /> i-a3-i� <br /> ���� ��z�� �2�. �Vu,i ��yU� CVYlZ�'�7'T, wa- �18203 <br /> PROJECT ADDRESS <br /> Owner �dail Atltlress City State2ip Phone <br /> �UI[q '��r�'2`aAb C�� AAF�LS[L /12� �� E]l��'� t.iJk Yg2o.3 <br /> Tenanl—t MailAddless -T C�ry �� Swte2iv 7nonc <br /> e �sss�a,-+ <br /> o.�rrz�L L�Na.u'r c 1J�G �! E /UR��a.frrJirw�rL tVGPcr� i.1'4' 9f�a� <br /> Elecincal Contrec or Mal qaaiass Ci�y Staca2ip Pnenn <br /> P��T �ir►a7- p�s339`i <br /> Sfalo L�cense Number(reduired) Gty of Everet� Businoss Licenso Number(roquirod� <br /> $ <br /> �Qj 5DO. Oc7 <br /> Propose0 Use o(Building Conlract Pnce ol Work <br /> Square Footage(If resitlenlial new construction,remodel or adddion) Cuntacl PersoNContact NumbedEmail <br /> Number of tlevices(If low vollage) • <br /> � � <br /> Descnp�ion of Work to Be Dono: L �*fJ- (7 5 A-Mf� (�ip/'�J<7 � ��Z 5 �VR /�q�sfU�-�u� <br /> /��D 1��Sto�vNc:�— <br /> �,� /1(}-n�� �.� MJ �Lt� �" <br /> v���•— FEE <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 7105 /J �/f � O <br /> I hereby corlity fhaf I have read and oxamrnedlhis applicafion and knOw fho 5ame to be frue and <br /> ���� � <br /> correct. All p�ovisions of laws und ordinancos govoming this fypo o!wo�k wili bo complolod <br /> � whofhor spociliod hor�in or not Tho granting ol a permif doos nof prosumo fo give aulhority lo PERMIT# <br /> orolale or cancol the provisions olany othor stato or local!aw rugu/afing consfruction or No � <br /> po�foimance ol consfruction. Thaf I am aufhorizod�y U�e ownor ol fhis property to peAorm fhe ( 5 D( ^ ( �D <br /> work lor whrch applicafion is made and I compl�wlfh fhe Sta(e Contiacto�s Law 18.27 RCW and <br /> 296.200 WAC. <br /> '7'Y'�/il�ti _K.� �///Z�7D/.� <br /> —T�IgnaWre Dat <br /> ��,sE��a�F:o�. �'�G�� � Co� � y25 - 355- �y l _� _ <br />