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----- - - - i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF �VER{ETT PERMIT SERVICES <br /> 3200 CEDAR STRf_ET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> > <br /> l�3� ,/��a�- w� <br /> PROJECTADDRESS ��� <br />' /�e f it-t erv�S� Zlh.�� , YZ/`��� -���� <br /> �a <br /> Owne� M11ail Address Cdy SlatelZip Phene <br /> �l,/K.. � 7 ���1,Cu7U�^'IY�Z���" /✓/(qu'iWW' l/�V �1/N�J !!/� '"� <br /> Tenanl IdailAddress d Slate/Zip Phone <br /> ��%�,f,i�,�,r'�1�� ��c� l�,i���3�3�M�G-lD�/�1'�lCi�e�, GlA �l�D/� �1y�11,�l��l� <br /> Eleclrical Cont c�or Ma�l Address Cdy SlatelZ�p Phone <br /> I <br /> i�/�Ml� c��l� ���f?G� ? <br /> State !icense Number(required) ty of Everelt Business License Number(required) <br /> � . . �r �����vi�� � Y��s' _ � <br /> Co lract Price of Wark � <br /> Proposed Use o(�uilding //3��?3 `��/�I/ �i <br /> 12QaGaYef r � <br /> �-}0 1, ,1���,,�-� �'�,�', r�,����E�t���'r��' <br /> Square Footage (I es denlial new conslruc ion, remodel or addilion) Con acl PersonlConlacl Number/Email <br /> Number of devices(If low voilage) <br /> Descrip�ion of Work l0 8e Cone:W_�Y�' P�/���/!,�i �� ,�}Q� / /IfMp /{�� �0�� <br /> ' '�d 1` /Letc/ l�6_�ct�T a�� s`hieP. ���1� G✓/'G�'��l f4�/� <br /> �a.60.r��' <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I �/ (�, �� <br /> � <br /> 1 hereby certily lhat 1 h��e rcad and examined fhis opplication and kno�v the same fo be true and ; <br /> cor,ecL All provisions of Imvs and ordinances goveming fhis fype ol work wiff be co��plefed <br /> whether speci(ed herein ornot The granling ol a pennit does nof presume fo give aufhonty lo PERMIT# <br /> violate or cancel(he prnvisions ol any ofher state or local law regulating conslruction or(he <br /> peAonnance ol consWction. Thaf I am authonzed by fhe o�vner ol fhis pmperty to perform lhe � ' L.� O g— , 3 <br /> wo�k lor�vhich application is mada and 1 compry wilh fhe Stafe Confractors Laiv 18.27 RCW and <br /> 296200 WAC. <br /> � ���, �� <br /> Signalure Dale <br /> HEVISEOO&96201J <br />