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i <br /> I i <br /> � ELECTRICAL PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STR[ET, EVERETT, VV/� 98201 I <br /> 425-257-f38�0 - FAX 425-257-8857 -�;rww everelt�.tia org � <br /> � <br /> I <br /> 22Z 7 �yr s! ,v�� �i I <br /> PROJECT ADDRESS <br /> � ,!^/1� _ �'G"�'� -- — --- -- - -- � <br /> (�v�rer r.�a��nceress -- --- ��ry SlateN.P .__.Vnonc <br /> Tenan�— '——_ _ _—__�tail Addres;.___-_ —_ _`.Y--_ _. -- SIa'e2 p Pr�crc <br /> �//f/�S l'CtsrPic G�c ?giq �.r„�r.eann�� l-�hrasrtvw�i -- -Wrr /��?5�' �-IT�i_Si9' 3vdz i <br /> EledncalCon'ractor ^.tadACoress C�t� Slatcl�p f'hc�c <br /> / I a`�'�-���- <br /> �'i�M 5�� 9a 2 t�6 _ - `-`PL' .'e c�— -- -- <br /> S�ate I icr;��;r, �Lmbrr (;cqmrcA) Cdy ol[vcre'1 6�i ress L�cerse Number(requrtcd) <br /> I Slr'� � �/���� _ --- <br /> � ('ionr��cd U=.�.(fiur.l�ry ___ _ -_ ..rn'r�el Prrn n(l:^,rk <br /> i <br /> i <br /> � gyua�,�Fr,c;t;�g�H r�1!iai nr,w conslrudion, remedel er adeldion) Cen!ad PersonlContact Nurnberl[mad <br /> INumhr.r ol devices (I!low vollage) <br /> IDescnplion o1 Work �o De Dore�. W I RG �C�/ ��✓�^�' <br /> I IfEE — — _ — <br /> I CITY OF EVERETT LOCAL SAL[S TA%CODE IS J105 � I �YyV 1 O% <br /> �(/`/I <br /> 1 hca by cer0/y thnt I h��ve read�ind crarnined flns�ipphr.:�hun and Mnow IAc same lu tn Inie and _ � <br /> � carecf All provrsions o/laws anJ ordmancr.s govemin�/Ihis fypo ol wo�k rnll Ge complefed - - --- � �--- I <br /> whefhnr sp�r.fieU hemin or nof. (he granhng o/a pennif durs nof pmsurn��lo give authnnty fu � p[RP1IT7 I <br /> violafr, urtancelfheprovirionsolaryut�u�rslaleurlor.all;uvrr,gulahnqronslnichonorfhe I � I�D' I ^ I/��� i <br /> peAonnance ol conslrucfiun Ihat 1 am��ulhonted by Ihe rnvner o/fhis proaeRy tu�,r.Aomi Ihe �-f' (/� <br /> �vork/on•;hich npphcafiun is madr, ��d I r,urrrpty mfh(he Stafe Cordiacfo�s Law 1 B 27 KCW and L---- -- . -- <br /> 290 200 AC. � <br /> y 2y/s <br /> /��_ _ . ' __ ._ .____—Daie _-__ -- _._.. <br /> ignaMe <br /> , I <br />