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�f�„ 1ti �i11G, �,il�A�� - n,J : I�„ i„ <br />i11 , f� 1 0(1 G � <br />,_ _ _ _ _ . . �i�i _ _ u i� �� _ . . u i i � a �i � � i� _ � _ / / � � L <br />I <br />� �/ � e • <br />.. .i <br />ELECTRICAL P�RMIT APPLICATION <br />C[TY OF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EV�,RETT, WA 982�1 `� <br />q�25-257-8810 � FAX q�25-257�8$57 �-,vwvw.ev�rettwa.org <br />,, <br />.����r.� <br />PROJECT ADDRESS <br />, � , ' <br />'' ��-1 s�'Z.� ;'' �,�'�-�n �,'�� �. <br />Own�r <br />Mail Add�ess <br />6 <br />5tate/Zip <br />� �� <br />Phone <br />Tellatlt Mail Address City 5iate/Zip Phone <br />J /,/ ��� � <br />c�Cf �, ����.�i`c�. �� ( ��r�� rtic S� �t t P.�P,�' � `It1 � �8'� � Z �5 �-�� (� S.S <br />Electrical Contrdctor Mail Address City State2ip Phone <br />���/���li/���1� ������ <br />State �.icense Number (required) City of Everett Susiness License Number (required) <br />U l t�l�. �c�'1 � �. ��� � <br />proposed Use of uiiding . Contract Price af Work <br />� �. �s�� I a5� <br />Square Footage (if residentfal new constructiom, Temo�el or addifian) Contact Per on/Contact Number/Email <br />f 1 , <br />i <br />iVumber of devices (If low volfage) <br />Descripiion of Work to e� Dona; l <br />� C�� ���� <br />��=��� � � ���� <br />� 4 <br />!� I ss � /�`'c�S -� <br />.�. . <br />�, r �EE <br />�• <br />CITY OF EVERFTT LOCAL SALES TAX CODE IS 3105 � ����_ <br />I hereby c�rfify that 1 have read and examined thls application and know the same to be true and <br />correcf. All provisions of laws snd ordin�nces governing this type of work will be completed <br />whefher specified herein ornot. The gr�nfing af a permit does not presume to give auihority fo PERMIT# <br />violafe or cancel the provisions of any othersfate orlocal law regulaEing ConsLruction or the ,, <br />performance of construction. Th�t 1 am authorrzed by the Owner of fhis propetty to perform fhe ��✓� I-��- i�� 71 j� <br />work for which �pplicafion is made and l comply with the St�te Contrsetors Law 18.27 RCW and �' � � <br />296.200, WAC. _ <br />r �-l(�--1 S^ <br />ature <br />� �S� `� 7 � ; �� Y �--_ <br />RevrsEo oeiof,/2o1a <br />