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ELECTRd�AL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />_ l y 3 2 ��i� 2�-`�' � J�--� <br />PROJECT ADDRESS <br />7-�1b�—l�f <br />G w iuo� � <br />� �-I N F� x '��45' %�,T �1- S i �l�f�—` 1* �2�3 '-f2� 3� S—� <br />O�vner MadAddress Ciry State2ip Phonc <br />Tenanl <br />Mail Address <br />City <br />State2p <br />Phone <br />k�ASS�r� ��ECr2iC�L C£Z�� f�.�� i� �►��1? `j?zo� yzS33S- <br />Elecirica!Conlractor MadAddress Cny SlateiLp Phone <br />k6�.19 �5� �8 `�% Pc", - <br />State License Numbcr <br />QE5 1 �fJ L� <br />Proposed Usc of Building <br />Square Fnotage Qf residential new conslruclion, remodel or addition) <br />Number of devices (If low voltage) <br />CoNracl Pricc of Work <br />Conlact Person (Plan Review) <br />Descript�an of Work ta Hc Donc _��_ �� C-1 Q�'L 1�S �1'�1 � 5/�7�) C� <br />�- - ��?' �c �'1�(1—� - <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �705 <br />! hcreby certily thaf I havc read r,nd ezanrined this opplicafion and know ffre sarne lo bc Inie anJ <br />r.orrecf. All provisions allaws and orrfinancr,s yovr.ming this ry�c oi �Yon� �vru n� �o��,�i�i�� <br />whr,fhr.r speciled horein ornot TAe gn. n(ing ol a pemii( ducs riot presume fo give aulho�ity (o <br />violnfe oi cancel the provisions ol any o(hei slale or /ocal law regulahny cons(n�chon �r Ihe <br />per/ormance of cnnslniclion Thaf I arn mdhonzed by Ihe rnvner olll�is property fo pr.Aonn Ihe <br />wo�k Ior whicb appOcafion is mndc a�,d i com�ry �v�u� rn�, S�afc Confrac(ors Law 18.27 RCW and <br />296.200 WAC <br />2 /�/�y <br />---- ---- --- --------------- <br />Si alwe Dalc <br />irr �vscn v.�mn <br />FEE-- ---- -- <br />7�°c� <br />— -- --- -- - _ - -- <br />PFRMffJt <br />EINl�IO�-ooz <br />�� <br />% <br />