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� <br />� <br />ELECTRICAL PERMIT APPLICATION <br />.�2 <br />PROJECT ADDRESS <br />M� <br />Owncr <br />Tenanl I � <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />/?___t,! GiG� � `J E �l L.�E! % � A <br />0/��Nrs <br />Mad Address <br />P/� c NiS <br />Mad Addmss <br />U�� /�-vC <br />Slalc2ip <br />2aG �ls�,,'oo �/ <br />Pro�� <br />� nc <br />c51lJ�[�'� C(.-�C7�iG I`�UZZ �iS�/��1CW Su iiL`fl �--`/N�.lwGo� W/l q <br />EleclncalContractor MailAdAress Gty Stalef7�p. PAone <br />51nr►.�� j`? (D Q� <br />Statc Llcense Number (reQuired) <br />�l�(L <br />Proposed Use of BuilAing <br />Square Footage Q( residential new conslruc�ioq remodel or addilion) <br />Numbr.r of devices (II low volla�e) <br />G�'�If � <br />Gty of Everett Business License Numbcr (required) <br />� ��DO, oa <br />CoMract Pricc ol Work <br />�-1US7?n/ Zs-��(39�Q`� <br />Contacl PersonlContact Numbr /Emall <br />5�-2NIcC- °� �t�.uE(L���7(Zf <br />Descriplion of Work lu Be Done: _� DJ � GL 2'LU l� 5 %� �--2UN ( CO (,rN i pr` <br />S c'T� iJ � L� �(-�'�/ f�1 �iL_ <br />�( C I <br />C�,. �iv./ IA/(1=N ✓�Li" - �� � <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 1705 <br />I hereGy certdy thaf 1 have read and oaanrined fhis applicafion and hnow fhe same fo be huo antl <br />co�r,cf. All provisions o! hvws and ortlinances goveming fhis type o! work will be complefed <br />whNhM specNied herein or nnf. Thc granfiny ol a permR docs nol piesumr, fo givo aufhonty lo <br />violale or conr.cl fhe provisions ol any olher sWfe or local law regulafing consfmclion or the <br />pedonrrarrce ol constmr.fion. Thaf I am aufhodzed by fhe owner o/ Ihis pmperly fo pedo�m fhe <br />work lor whic �pp6r.ation is made and 1 comply wdh fhc Slalc Conlmcfors Law 7tl27 RCW and <br />796.200 WAC� /� � / <br />FE[ <br />�l�U. srb <br />PERMIT# <br />E I�N(-c��f <br />�aM <br />