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i- - _ ._ _ _ - - <br /> i <br /> � ELECTRICAL PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> I 3200 C6DAR STREET, EVERETT, WA 98201 <br /> I425-257-8810 - FAX 425-257-8857 —www everettH�a org <br /> oC�U`� L. �.4.S�nfJ �1k,tCltt' �t��� i <br /> "�CC.J(��' DRES �O\Z <br /> ^�:�iY.- .el��_{�C�S�K�.IY^._ ��+� 1A1�. �t����-- �------- <br /> O�•mcr Ma�l Address Gty St�tcll�p Phone <br /> o{�s � c�cket L(,C- ------- --- <br /> -�--- <br /> Tenant 61a�i AGtlress � C�ty StateZp Phone <br /> ��S''Z�.� <br /> � _ ���Q ti�e_���.�5 s+ N�(��c,� ���s �Jh. �82Sa �58g <br /> [Iectncal Conlrattor 1Aaa Aadress Gry State2p Phone <br /> ' �� I <br /> — i <br /> Slale License Number C Nrad Price of Work I <br /> — --- — I <br /> Proposed Use of P �ddmg Contact Person (Plan Review) I <br /> i ISquare Footage pf residential new conslruction, remodel or adtldion) <br /> I <br /> Number ol dev�ces(It low vollage) <br /> Descnption ol Work to[�e Donc T"��"�L�-Cl� \ L.�LUI�S_ ______!_� - - � <br /> ----- ——-------- -- -—� ---� ---- ------—�--------� —_ I <br /> I I <br /> � ��-- ----- -�---- _. <br /> , FFF. <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 � � SO � <br /> 1 heieby certAy fhal I hevc read and c+arnined tlris applicafion and know thc sarne(o be(rur and _ __. I <br /> tormc�. All pmvisions o/la�vs anU ortlmances 9oveming lhis type ol worN wdl be completed ---------�'—�--� <br /> whefhcr specificd bcrcin or no(. 71m grnnhn9 0l a pr.mnt Aucs nol presume fo givc authonty to P[RMITn <br /> vrolate or cancel lhe provsions ol any ofher sfafe or local/aw,egiJatinq consfrucfion or the '` <br /> perlormonce ol consfniclion. rhaf I arn aufhonzed Uy fhe o�vne�ol Pvs pr�perty ro perlom�Nir. E I lJ-O� I�r� <br /> �vorh /or�vh�ch applicahon rs made anA 1 compty�vifh fhe Stofe Contmclors Law 18 77 HC W anJ ___�____. �-J__—_. J <br /> 79G 200 WAC <br /> f� <br /> � --- ------�`�'y_s�,�.�� I <br /> S�y^�alure Date <br /> ncwsr��ir. �i . � <br />