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�_ _- - - - __ _- �- --. -- - ----, <br /> I ELECTRICAL PERMIT APPLICATION <br /> ; CITY OF EVERETT PERMIT SERVICES � <br /> � 3200 CEDAR STREET, FVERETT, WA 98201 i <br /> � 425-257-8810 - FAX 425-257-8857 - www everettwa ory I <br /> �/!�/2 -D� � <br /> i /,Z -cJ__��l � <br /> J�UU3 b-c�s� c�a-s��o KD• - `f"D-5� <br /> PROJECTADDRESS <br /> II � <br /> �'� �i <br /> Owner MaAAadress C�ry �� S�ate2p t'ho�e � <br /> I <br /> &��«ti - -- - - - - <br /> ienanl MalAtl7ress City Sta!e2ip Phone � <br /> �4:-5� <br /> S�c�-,,i.e��t�.+ 1�i35 titE 9y-" i2�Or^r,��h �.s� ��'6SL _-- ��a-(��o , <br /> [Iec�ntalConiractor �da�lAtltlre55 Cny Sta�e�Zia Pao�e <br /> S�i,tO F L 9'7'7 SGj 401�� _ - - <br /> State License Number(reqwred) Cdy ol Everett Business L�cense Number (requ�red) <br /> �h1��LSi?--I A-t-.� — ����'�-�fU _ <br /> I PropoSed Use of Build�ng ConlraU Pnce of Woik <br /> (q �5�343-6os <br /> �jl�P�f P�u-f"1F}....� - - - <br /> Square Foolage(If residential new construction,remodel or addilion) Conlact PersonlConlatl Num6er/Ema�l <br /> Number of dev�r,es(111ow vulla�e) <br /> Descriplion of Work ta Be Donc: ��'2'� u�i�/-��.-�� �''%����C�-�'�^a�� lf� tT�{„'t I <br /> ��A-��� `F�[S5 — �ME3Y3 �i.�l�ut���� L�e�u-;�,..Lr� GJ,.-e.rQe�� <br /> ►�t1.--���-- - - <br /> --- -- - ----- ----- - _ � <br /> FEE � �� - — I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 � �/ _ <br /> !hereby�cridy fhat I havc read anA exammed fhis applicahon and kno�v�he same(o be f�uc and ___ �� <br /> coner.t All prov�siorrs o/laws and ordinances govemin9 this type ol woitc will Ge complefed - ------� <br /> whefher specdicd h.wein or not. Ihe granfmg o/a pe�md does not pmsume fo grve aufhonlv fo PFRMIT# <br /> v�olafe or cancel IhN prov�s�ons ol any ofher sfafe or local�ew regvla(ing consfrucfron or fhe rj� <br /> pednrmance o/consfn�ctron. Thal I am aufhonaed by the�wner ol this pwpeny fo peAonn�he E �� I Z � O `��J <br /> work(or wh¢h applicahon Is made and I comply�wfh fhe Sta(e Conf�acrors Law 18.27 RCW and ,_ <br /> 296 2�WA��/����",." """ " — � <br /> !J�Cj�1 c� <br /> SignaWre Dale i <br /> REVISFD 0606RJN � <br />