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07!07/2016 09: 33 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 /> ;-(0C:90 ec{S .1\G <br /> PROJECT ADDRESS <br /> ATS <br /> Owner Mail Address City State/Zip Phone • <br /> 090,106 c, ek.4-3 <br /> Tenant Mail Address City State/21p Phone <br /> dr:c_ Cot► PO (off c0 :.‘v;((e (00FD tf)S t!a'S t( ( <br /> Electrical Contractor Mail Address City state/Zip Phone <br /> i-#-TI-L+EC. 04(56T 031 508 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) ��(r tt 1 �i� 'r <br /> Description of Work to Be Done: 1{15..{{ +1( (>5e v mO{(Z j_(r`1~D r c epL>L(e -gyp <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 S <br /> /hereby certify that t 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 / �,l • <br /> performance of construction. That l am authorized by the owner of this property to perform the E lot 7 - t) <br /> work for which application is made and!comply with the State Contractors Law 98.27 RCW and <br /> 296.200 C. <br /> /7 Del( t <br /> Signature Data <br /> REVISED O13/O6J20! <br />