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EL��1'RICAL PERMIT APPLI�ATION <br /> CITY OF EVEF�ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88�0 — FAX 425-257-8857— t.a,/ty�.sJ_����.�,r�.`�=�.+��.��7 y <br /> �h,a�,�i f'. �V/L i e`�f`�-�.�S � ���t�r'��'� i��GL- •y�,� �t <br /> � <br /> �- ��''. � ��5 � .�, <br /> PROJECT ADDRESS <br /> t�� i,D �E f, � ���.? �.��:Y�� ��ny �( �,Z� f <br /> Owner Mail Address Cit <br /> Y State/Zip Phone <br /> , ;i <br /> 'f urt!�'}?J i Ci,� U,�r•r <br /> . �. <br /> Tenanl Mail�ddress City State/Zip Phone <br /> �����`l'7Lr� �LG'U�'I�1 L ��b i��X `�L�1 �t 1'�-�-i.+Ai-iJ �i G� G� ' <br /> �,. � v� �'S ��j��� ��lZ-Zc� 12, <br /> Electrical Contractor Mafl Address Cit <br /> y Slate/Zip Phone <br /> ���, ... <br /> � ��..,�fl,��� � 3�`� �.!'i �`'c.� �1� <br /> State License Number(required) City of Everett Business License Number(requiredJ <br /> ' E��E��'�TrL�.�.�'tS � �__� <br /> Proposed Use of Buifding Contract Price of Work <br /> Square Footage (If residential new construction, remodel or addition r������ � S�-�Oh`��°`'�'��'- ,v;,,j L;N�c.,�;.F,,� <br /> ) . Contact Person/Contact Number/Emaii <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: �-�S�t^-�T1L/C7�'l��j• $�F1V i N L �t�-���,-�Li��-�,,,� �� ��G��--� <br /> I <br /> � ��� �-�i J S 1 _ ���:J L��'.'� ���Jti�.� 1 ?' {�..i✓'-L�i 5 !.� <br /> FEE <br /> ClTY OF EVERETi'LOCAL SALES TAX CODE IS 3105 �1� <br /> ��V <br /> l hereby cerfify that l have read and examined this application and know the same to be true and <br /> correct. Al!provisions of/aws and ordinances governing this fype of work tvil!be completed <br /> whether specified herein or not. The granting of a permit does nof presume fo give authority to PERMIT# <br /> violate or cancel the provisions of an,y otfrer state or local!aw regulating construction or fhe <br /> performance of construcfion, Thaf 1 am authorrzed by fhe owner of this property to perform the �j <br /> tvor/t for whrch app/ication is made and!comply vvith the State Confractors Law 18.27 RCW and � I�O I - I �� <br /> 296.200 WAC. <br /> ;�� ! f ��' <br /> ��, .'� �,� , �c, !E �l� � <br /> Signature � <br /> j Date <br /> r�evis�oosroc.nora _��r-LL � ��`-�-9� • . <br />