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i - - - ----- — -- -- - . _ . -----__-- - <br /> � ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www everettwa.org <br /> Z SI I [ �pA-Iz ;-t-iZFE r C VC" KC 17- 1.�� � <br /> PROJECTADDRESS ���o� <br /> �E ^�SrR. �E-n2c�l Z�ll C���� `°'� CUfk'E-rr- t-ul- ��I?S�ZSZ — �`1 �� <br /> Owncr M11ad Ad9ess � Crty State2�p Phone <br /> Tenan! Idad ACO�ess Cdy Siate2�p Phone <br /> �sFn�31`r <br /> VA.J�F_�r�i- �IE �Tk1c 2Dc3Z NSc� UUE Sr �i�.ecs•�`?�> . l,�t `1�Z�3 6izz <br /> Electrical Con�raclor Ma�l Address Ciry State�Lp P�one <br /> � � <br /> �J� <br /> I �fp_�rC[ �' Y,1S,�C — — <br /> ' Stale License Number Conlracl Pnce o1 Work <br /> I --- <br /> � ProFased Use of Ouddmg Conlad Person (Plan Rewewl <br /> i <br /> I <br /> Square Foolage�If res�dential new conslrucuon, iemodel ar aAdAionl <br />� Number of devices pl low vollage) <br /> pr.scnplion ol Wo�k fo Hc Donc: �F�-�C P-T-C� �SIZ�c.`"L'r- -Tz' i-�(QT Pl�.M )� �''; <br /> I <br /> FFE _ — ---- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 j„ bV�1 <br /> I hereby certdy fhal I have ir.nA,�rrd eramineAflris app6calron nnd kno�v(he sarne lo be frue and .----`�_-_— --- — <br /> correcf. All provis�ons ol laws and ordmances govemin9 fhis lype ol work will be cornplMed --- <br /> whefher specdieAherein or not. T,ir. gr,vnting o/a pemut Jnes nof presunre lo g�ve a!dhnnty Ic PFRMITN <br /> violate or cancel fhe prowsiorrs ol any olher sfafe or�ocal law�egulafrng consfruc6nn o� 'he � I � ( 1 _ I � I I <br /> peAormance ol consfn�clion. Ihnl I am aufhonzed ly the owne�ol fhis property fo pe�fi nn fhe L <br /> isork/or�vhich applrcalion is made and I comply H�dh pie Stale Confracfors!.o�v 18 27 k;W and ____ _ __. <br /> 296 2 Wly� <br /> \� � ��-- <br /> 17 / I �� /13 <br /> Signalure Date <br /> we�-�sru vta-n <br /> �---` --- -- ---`--�- -- ---------- --. _J <br />