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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 %0"/9- 1 y <br />425-257-8810 - FAX 425-257-8857 - vnv.v everettwa org <br />,2802- WL-TAAOP-c ACE EVtn6TV, W QiSZOi <br />PROJECT ADDRESS C/ Z 5 3 ZO- <br />TQfnl IT Y LUTNEp,43 CO(-k-rGC z$OZ WE-FMOeE AJ Lf- i-�l02ETi , u) t � Zt1L <br />Owner Mail Address City State2a Phore <br />( fI <br />Tenant triad Address City Slate/Zip Pnone <br />20fo '?3'3 oz25 <br />t5jy.A01-1D5 qu—oQillPtCOMrA WC- ��f310 �(7� IgVE W iEbN40Nb$t tu✓{ C, SOZr _ <br />Electrical Contractor Mail Address Cdy State/Zip Pnone <br />6f)mGNX C R(0-z bib a5J5 <br />State License Number (required) City of Everett Business License Number (required) <br />sfzt4Qoo <br />Proposed Use of Building Contract Price of Work <br />(<eor*P-E;y NE :r 2b(ol33 o2z5 <br />Square Footage (If residential new construction, remodel or addition) Contact PeisonhContart Number/Email <br />Number of devices (II low voltage) <br />Description of Work to Be Done. Cyjc-AL51oti1 Or y cxr\/ CC)tinrk0kak Aom0l,I �112ES <br />FO)O- 2CLOCAT(N& C&nOL)IT 7D Me6F Gr7V RE©IJIraCMeiPi <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 50 <br />"52 <br />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. .NI provisions of laws and ordinances governing this type of work will be completed <br />whetherspecified herein ornol. The granting of a permit does not presume to give authonty to PERMI r# <br />violate or cancel the provisions of any other state or local law regulating construction or the r I D — <br />perfonnance of construction. That I am authorized by the owner of this property to perform the C <br />wotk for IV <br />h appfcation is made and I comply with the State Contractors Law 18.27 RCW and <br />296.2 W <br />Sol I P. - Date <br />REV15ED06N6701e <br />