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� _ _ __ _-- - ---- - - ------ ---- _ _ -- _ _ , <br /> � <br /> � ELECTRICAL PERMIT APPLICATION <br /> ; CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERElT, WA 99201 <br /> 425-257-8810 - FAX 425-257•8857 —www evereltv+a.org <br /> I� I 1 l LtSC��(�C- l 1�r <br /> PROJECT ADDRESS <br /> Owner ---- fdadAtldress C�ty --------� .Stale/Lp Pnone I <br /> Tenan� MaJAddress Gty S1ale2�p Phone <br /> � n uzS�Sn�-�3 <br /> nn s,�k- �1��h-.�,tc� ���s3 ► A,L �U� s�,�kl-3�3 r'l�s�;ll� ��2-,� � <br /> Elec�rical Contraclor v fda�l Addiess Cdy �—S�ate�Z�p Fhone j <br /> S �T EI-5��sKo�4 os 132 7 <br /> Slate License Num6er(requ�red) Cdy ol[verett �usiness License Number(reqmred) <br /> L,�,,��. S'r R-- -- - - - -- <br /> Propose se ol�wld�ng Contract Pnce ot Work � <br /> r�."��" y2S_ ��- 755) ' <br /> � Syuare Footage(If residenlial new construclion, remodel or addition) CoMatt PersonlContact Number�Emad I <br /> Number o1 devices(If law votlage) <br /> Descriplion ol Work lo Be Done�. �f� ��U��� I ��< <- SMo���- q I�'�S�u^� ��` ___ <br /> S�ol�� �a-��-,�� . ---- --- —_ <br /> �--- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES?AX CODE IS J105 �� <br /> 1 hereGy cerLly Ihaf I have mad nnd exanvned(h�s npplicat�on nnd knmv fhe same fo be We and ---._--- --_---- <br /> conrcf. �111 pmvisions o/laws nrrd ortl�nonces goveming th�s type ol woM wdl Ge cornplefed -- - --- ------ - <br /> �vhethci speci(ed hemrn or nnf. 1he 9ranhn9 0/a pennd does nof presumr, to give aufhorrty fo PERMIT 7J <br /> wolafe or cancel fhe provisions ol any ofher sfnfe oi local li�v regulafing conSGucfion or(hr. ^ � �`0�— 0� � <br /> performnnco ol constnic(ion Tlrof I am aufhonred by fhe owner ol fhis p�opr.rty(o perlom�fh� C �I <br /> n�ork lor wh�ch applrcafron is made and I comply�vdh Ihe Sfafe Con(ncfors La�v 18 27 RCW��nd <br /> 296 200 WAC. <br /> / /� ^ <br /> S�gnaWre � / � �Uate <br /> rR�i_'f0�6c6zarl <br />