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r.. " ^^ t, <br />_ � �"�� 3 .c'rr <br />�� ��c; j � <br />ELECTRICA'L PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR 51REET, EVERETT, V✓A 9d201 <br />425-?57-8810 - FAX425-257f38S7—wvnveverettwaorg <br />��sio -� �6 <br />, � �r��1�. ��,�,�-, �o_�s—/S <br />', PROJECTADDRESS <br />UHner <br />Tenan; <br />Eledncal Coniractor <br />1 <br />' .��i�ShS'�30�� <br />� <br />; S'ale Lcerse Number (reCulred) <br />� 4�cS,Ac��i:� <br />� Proposed Usc of 8ul'tlinA <br />�� <br />Mail ACdrese <br />Ide7 h0aresc <br />'AY�,I A�tl�bcs <br />Sauare Foolago (�1 msdeni�al newconslructioq remodel m addiLon) <br />Nwnber oF dewces pf low vollage) <br />Descrlp6on of Work lo Bo Oonu: <br />CIIY OF LVERCT" LOCAL SALES TAX CO�E IS J105 <br />C�ty <br />Ciry <br />$tB!o/Lp <br />Stale/Z�p <br />i � 2 �_�-� <br />$�ele2ip <br />P�ono <br />F'h�ne <br />PI;or9 <br />G1�'t ��ess Lic^rse Number (required) <br />1�-II�U 00 <br />Contrad Price of 1'Jark <br />�111.1.1,V1 �v p MAF-f <br />CoNacl Fcrecn/Contact NumbedEmaii <br />1) E�,u,v� @�jS1tiF��+^,y • C av�n <br />� hcrchy certlh,� �Anf U�avo read erd nxamined fAis applrcaGon anJ know tho same to 6o Irvo and <br />corroct AIf p�ovisions o�laws and oMmanms govemma fl�is fype ol work n•ill Da comph±�ed <br />whethcr spedhed hemin or no(. Tiie prsn(inp of a pormrf Ooes nof presumo fo grve aufhvnty to <br />viclafo or cancel 7he provisions ol any othcr sfafo or Icic�i �aw icaul�ling consf�uct/on or Ihe <br />perinrmanre o! construclion. That I nm eulh.�d7nd by fhe ow,ior ol (his prpporty fo porlorm Uio <br />woik loi whieb applicaGon is m�da ana / compty wi�r fr,c Sfa(c C�nbaclors Lew 10.27 ftCW nnd <br />7a6.200 W�f� <br />REVISEOCbtb^Of1 <br />jFEE � <br />�/ D p0 <br />c�j <br />PERMI7N <br />C ���� � ollQ � <br />- --� .�—_.�_1 <br />