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- -- - - - -� -- - - - -- � - _ _ -- - <br /> ; ELECTRICAL PERMIT APPLICATION ! <br /> ' CITY OF EVERETT PERMIT SERVICES ' <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810 - FAX 425-257-8857 -www everettwacrg <br /> ��� �l y/a"���- <br /> �� �/ i/i/ ��Si�� ��UG)c�, �i/C'�-��, ��/,� `/�'���q- /D ��il -�y <br /> PROJECT ADDRESS ' <br /> J _ ., �.�'✓� _ -- -- — --- -- -- -- ' <br /> UwnB� �dailAddress C�ty Stalc%Z�p VFone � <br /> ��/S✓S�9 i�8 Z2�/U,/ G�s,���a: C�-�e� � wA _._`��r'21�" _ � <br /> lenanl - �—��--�— fdadAACress C4y Slater2m P�ore �, <br /> �Qi/.�/w �93r�/.�+T <br /> 6RC.�4X'1�Cr��i� � i'olor (l� , S`�c�7����Q — `�� ��'r-�t %a��35=9� <br /> '�. t�eUncal Conlractor fdaii qdd�ess Cdy Slate2,p � prone � <br /> �.� ���cs y�/�� _ _ O � "I 23 l <br /> ISlate License Number (reqwred) City ol Everett Dusiness License Number pequvetl) , <br /> � _ ..!��',>l�� - —. —__.--- ! <br /> �� Proposed Use of[3widing Contract Pnce of Woik �. <br /> � s .� � <br /> � �P��i,-o� �;nj<<. .1���_��J� )�r�= - <br /> ', Square �oolage pl residenUal new consirucbon,remodel or additionl Conlacl soNQ�ntect NumberlEmail � <br /> � �I <br /> Number ol devices (II low voitage) � <br /> �� �✓ '' 1 '�f ��!� �tY/1���(� � .�l�f�(iI�Y=� �a'if=���✓ � <br /> Descnplion ol Wmk to fle Done _ _�_ - - �—� -- — -- --:- � — — <br /> ' �,� f _i.zc ,���f�_P�,.���' ���r�_ 2 !�/G. �'��✓r'j.s .�? v���'(i� S-- - <br /> r �f.- — <br /> � _ {��r (�����-�•_ .—!�s���.� � ��j'm ��nu�f%cin/i�✓�� �'n��'''�--/�,U�d' ---- I'� <br /> tt <br /> �' FCf — -- _— — I <br /> li CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 �I � �j 7 . 5 � II �I <br /> � I hereby ceRity fhaf I have �eaA�nd r�anunr.d fhis apphc��Gnn and l�now Ihe srinic lo be (�uc��nJ l— —. _.__—_ -- . J �� <br /> cnrrecf. �II provisions o/Imvs and onlurances 9ovemuiq fhis fype ol�voi6 �vrll be cornUieted - --- - i <br /> �vliefhc� spca/icd hwe�n or nof The 9ranfmg o!a pemul Aor.s rrol presumr. fo give aufhonty fn p[NMII�# � <br /> �•�olate o�cancel fhe prowsions ol�ny ofber sfa(e or local Inw iegulafing conslruclron o�(he E � �� D - � g Z <br /> perlonrmnce ol tonshuchon 7hat I arn authonzed by Pre owner of this property to perlonn Ihr. <br /> � �vork/oi which appl�cation is maUe and I compty wdh the State Contracfors Law 18 21 RCW and _.__. __ __ . . ---. <br /> ?96 200 WAC <br /> � -_-_��� � — '�p�lQ�'j O�/� <br /> L� —�_—. . <br /> ignalure Da�e <br /> � aF��S'OCeCS:JN . . . _ __ _. _'__. . — . — — -- -.--. _ . _ _ ___ — _'. — _ . . . - .� <br />