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�: /15/=01C k?:U II : C7 F'1Y :�i Cli L1i8 �OG1/001 <br /> _� 1-e� � ca�l so _l cc�� c����� ���di � Ccc;r� <br /> ��ZS-q-�'3-� S��1 <br /> ELECTRICA� PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857 —ew�v,�.everottwa org <br /> GI</f�l --d�7� <br /> � 1� I �I I � �1� �}-. �- ;s-�� <br /> PROJECT ADDRESS � <br /> �Vt G _� -1 I '1 I � -�' S-f- ��' �ti-�,-� v.�q � �Zuf <br /> Owner Mal t.acras; Gry StatMZip Phanc <br /> �W`' I� _ � <br /> ienant 1.1ai1 Addrese Gty Sta!rJ7p Phcne <br /> n(�C �-1/iC CG7����u�t�i Ca��'C�� S CC�� j U� o� (-• iZiveSl !�� Dr. <br /> EfecVical Contractor 1,!all Addiess City I��.1 I n�Slat,�v�4� ��(�1 r'�rc <br /> 1�� 1 l � <br /> �1YC l �C C �11� � � <br /> Sfate License Number ContraU Pnce of Work <br /> Proposed Us^of Bullding Cantact Person (Plan R?view) <br /> �J�U �, <br /> Squam Foolzge(I(residential new construction,remodel or add��.tion) 'I <br /> � � I <br /> Number of devices(If Imv voitage) ''� <br /> Description of Work to(3e Done. �/ l�I C� � ����-1 ` l� ______ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 310E S D '�'✓ <br /> I horoby cr�rti/y(hof I lrave rcaJ and cxaminetl llus opplicalion and kno:v fhe samo fo Ge Oun and <br /> corrocL AU proi�isions ol laws and ordinancas goveming 1h�5 fype al work wd�bo cnmplofed - <br /> whcfherspeci�od hcrt:in ornat The�ranling ol n permi(doos nof pmsmr�o fo r�ivc aulhority fo PERMIT# � <br /> v;olote orcancal the provislons o/any ofherstote orlocal lo�v mr�uieflny r.onsfrt�c(ian ortho � � <br /> porlormance o(consducllon Th�t 1 am uufhonzed by fhe owner ol fhls pruporfy fo pe�fonn fho E I �O� -� Q 7 <br /> work(or whlch applic�fion is mnde nnd 1 compty wi(h the Sfato Confraclors La•�v 7@27 RCW and _ __ <br /> i 296.ZGO WAC. <br /> \ / C <br /> �C��S'�.�.�� � � � \ 5� 1� <br /> � ipnature Daie �— <br /> r[v15EJ3:✓U <br />