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� ELECTRICAL PERMIT APPLICATION <br /> C[TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> I— 09�/S <br /> E i,�oi-o�v <br /> _�OC?� �J• C'�'s� / ����. <br /> PROJECT ADDRESS C��Uv� <br /> Jl-,1„v'� - ..�:/Jtc_ ii,j����/,.�ii F�r�r'�'•'- -- -- -1� i�• <br /> Owner Mail Address � City Slale�Lp t'none <br /> ���T�.c%_ �- J .A<< ��c�� �o�v t�ii.fi'�•=T tv,� --- -- <br /> TCnanl �dail�ddres CRy Stale/Tip Phonr, <br /> i <br /> �� / _ ��/�r �J�' I✓C. - G•,�?- /J <br /> /1���'L�L�-�SL�Il.� �.Tifc F �i��'' �/ !-'iJ'.i:�i��_.����� <br /> .__.—__ —__ .._ ..____...—_. <br /> tlee�riCal Con�rattor Mad Address City Statc2�p Phenc <br /> TLt X/I�� 'l)1�.t�lc/ �✓_��L�.��__ ____.'._ <br /> Slale License Number(reywreA) Cdy ol Fveretl Business 1 icr.nse Number(required) <br /> -- �%.l/�GI <br /> . �; - <br /> G�/1-<t r — — /-- <br /> P«�posod Use of Birld�ng Conha�,t Pn r, 01 Work <br /> �rl=�/�%+iCI�<� <br /> (j�dG)l.s.�-..�j/U �j•Jti//✓c%(.� Ct/�.�C Cd.� <br /> Squere fooiayr. QI ics�drnhul ncai��mslruction, remadN or ndAdion) Cunta�.l PeisorNConlai,l NumbndCm.ul � <br /> � � <br /> Numbcr of devires(If low valLign) <br /> Desr.riphon ol Work to Hc Uone ==*'�Ii i1�f_ /=-i��.,f�G�.�i:%c��qJi'_Cir1_ -�-�[ . . .. <br /> — . I- <br /> _,d�zJ Ft=��_�_ �_.��:��,����C�.�. <br /> rr� -- <br /> CITY OF EVERLiT LOCAL SALES TAX CODE IS J105 I R L'� D <br /> I limr,by ccrtily lhnl I h�ivc rcaJ ond ce;vninad(hi.�npplir:aGon rind knovi llic s.�n�r. fu bc 6vu and _ . . .__ .. —. -- --_. <br /> cnrrecf. NI pruvi�inns ullnws nnd nnhnanr.c:govcrning Ihr,typv ul rorl;rnll bc complcfcd --- — --- — <br /> whrtfhe��pc�a/cd licrum or nof. 1 hc qranbny o/u penrrd Jucs nol pmswnr, fo�ivo nufhnnty(o PCRMIT# <br /> viol,�fo or r;ancel f6n pnrvisions ol any nfher sf:�le nr loc,d lo�v n;yvGihny consfruc(ion or fhr, ^ <br /> prAormnncn nl crnr.slmcfinn 7h,�f I am nulhonred by fhc uwncr nl Iha p�opivty lo perlom�fhn t �5 o I - � �(S <br /> work loi whrch �pplir.nfion c:ninde rmd 1 r.omply wdh Ihr. Slafc f,nnb�iclors iew 1B 2I fiCW�inA -- -- _ --_-- _ .-- <br /> 29G 200 WA ' <br /> / <br /> .li.._ � �,���� �G' .�)�'.'S � . <br /> Siyua�ur . _.- ____ Datn - - — _. ._-.._ - <br /> i:� i�TI(�nft�)NIOII <br />