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04108/2016 10: 58 4254854320 HILL ELECTRIC PAGE 02/02 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> • <br /> Q(00 W cc l ietet (keol <br /> PROJECT ADDRESS Av i k t &t A C/YVI c S <br /> ,-TS 3 r a( (G{' Si S(A f r qS 2A 3 <br /> Owner Mail Address Gity State/Zip Phone <br /> ,I VeV,�o�t c 5 Ex e egf <br /> Tenant Mail Address City State/Zip Phone <br /> (1:(( e(cc r.c corpPa f3ox (on coca`•,•0:({e kook ?ola Lf -S k 3a.! <br /> Electrical Contractor Mail Addreas City State/Zip Phone <br /> 4-r LL coq o.5(5'o 0 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Wocfre(A.0--1.se q, c© <br /> Proposed Use of Building Contract Price of Work <br /> S1Acr A Tm rs%(a tf�5 �fg'.� �t3� <br /> Square Footage(If residential new construction,remodel or addition) Contact P ra n/ ct umber/Email <br /> cop eptcvein, <br /> • <br /> Number of devices(If low voltage) _ <br /> Description of Work to Be Done: .x4.-C socsfc e c plc( jcvA <br /> - Ns- merI Pith ( $A a"eS/'f Off/ -esc C ( vo-F'+ d S-4t:(Fe vhrecc.;,.Q, <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 Z(55 O� <br /> l hereby certify that/have read and examined this application and know the same to be true and <br /> correct, All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E 104- 0(62. <br /> work for which application is made and I comply with the State Contractors Law 18.27 ROW and <br /> 296.200 WAC. <br /> _ orf s©g/ c1( <br /> 'Signa 7 e Date <br /> REVISED 0Bl06/2014 <br />