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---- I <br /> ELECTRICAL PERMIT APPLICATION ' <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everethva.org <br /> � <br /> �-�'acVl -� : Pe(M i+ �:SI�!a-oo <br /> j$Qq l�� _ �rad��Wa� <br /> PROJECT ADDRESS <br /> ' �� Rr� r�n c �01 S S�� W j'�11Ssoula MT 5��0 ( ��106��«'�-l191 <br /> Owner Mai�Address C�ry Stale2p Pnone <br /> �uij� ss1"e�1' �"aftooa-��er��„� )80`1 �r�A�w�tv �ve,��{�, �JA 9�� 1 <br /> Tenant MailAddr' Gty State/Zip Phone <br /> ' v� s s �`{ov F4u�deson Kc(. �ve(�ff- 1rJA 9Pao3 (���G-883s' <br /> Electnc I Con ac10r ldail Address City StalelZip Phone <br /> .�P�`�N�d85�� c�2y �B� <br /> � Stale L�cense Number(required) Cily of Everetl Business License Number(required) <br /> .�l ��0 <br /> Proposed Use of Building Contracl Price of Work <br /> �Ll��ica�s � <br /> Square Footaqe Qf residential new conslruction,remodel or additwn) Coniact Person/Contaci Numbe�lEmail I <br /> /lew�e.�mi�s Q�ber�yS Iq�15y5 f P,�».0 <br /> � r/ <br /> Number of devices(If low vollage) <br /> Description of Work to Be Done: �� U F— �W'e '�'� SI A Yl. <br /> FEE 0 �� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3t05 � <br /> I I hereby certily lhaf 1 have read and oxamined INis applicafion and know fho same fo be frue and <br /> conecf. All provisions o/laws and ordmances govern6ig this type o/work will be compleled <br /> whofher specified herein or noL The granling ol a permif does nof presunte fo givc aufhontylo PERMIT# <br /> Iviolate or cancel Ihe provisions ol any elher stafe or local law regulafing consfruction or Ihe ^ � , r � j` ��O I <br /> peAormance oI construcfion. Thaf 1 am aufhorizeA by Ihe owner o/lhis property(o perform the t �.� U <br /> , work lor which applicafion is made and 1 comply wifh Ihe Sfa(e Conlracfors Law 18.27 RCW and <br /> ! 296.200 WAC. <br /> ' ��K.e. ,17i,ert�C✓ s /x <br /> , Signatu Da� <br /> � <br /> � FCV:ED[y�^S:pfi <br />