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07/OD/?013 Ke0 t7: 37 P ix 425 988 fi501 sca-Copy �002/002 <br /> � ._____ _____. _ _ .__._ <br /> EL.ECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERM�T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810 - FAX 425-257-8857 —�wnv.everettwa org <br /> i� � 'JJ ('�.I��� � Iltr��.� :51( � l;(� <br /> , PROJECT ADDRESS <br /> Ilil(.il(G�'1 {��)�:�I ✓X:VVk. IID � •�(r.rrf I� �� .�i'o{.:r,' r�( i��ll ��1�iJl:J ���C��'� 5'f�( `.y5 / <br /> Owner A7ail Adtlrrss Ci1y Slafe/Zip P�one <br /> Itl� ic� �ca, i ��� 2J1 l�X,.l�k ��JJJ (',•lbi;,� llt:i' , .S�li Ii:O, L:.UI.� c,�i l�;�l �ISJi: I ( ����3'1'i ';Nfi , <br /> Tenant MailAddress Cdy SIa1rJ7_ip Phonc <br /> i'lll�.i �:l Sc�.�: 'l- VG�.1 � 31i.`�I CUC�IIr.� Kr.l 17uvlar� t.S)1 �1Si,`�1 � 'IJ`���1'�S �a;c, <br /> Eiectr�caiContraclor Me�lAddress C�ry siaierZ�p Phpne � <br /> il� i it- 5�'3 �1`�����?i <`� ' I � �l /:U . Rr <br /> Slale License Number Contrect Price ol Wmh <br /> jti1•(,I •�t�� Sii'tG.l'1 <br /> Proposed Use o(�wltlmg Contact Person (Plan Rewew) <br /> Square Footage(If residential new construction, remodel or addit�on) <br /> � lF <br /> Number ot devices(If low voltage) <br /> DesCriphonOfWOrktoBe�onc: l��i ��'�(1( 'C' '('.V �;%� �� \� �l:l,�) �I(; ���F,.-:l �%�,L{' ' �GV� ll �C,' � Il'1 <br /> FEE �CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 .�i � <br /> ✓ <br /> !he�aNy cerarly fh�t I frave mad and eA�ammr.d fhrs application nnd know fhe some to be frac and ___ <br /> r.onCCL A�t pmVisions o!l�ws.nd ordinarces goveming fhis fypc ol woNc�vill bo complefed <br /> whelher speci�ed herem or noL The.gmnfing of o permR tlocs not presurrre lo qrvB autDonty fo PERMIT# <br /> viola(e ur cnnce!Uie pruvisions o/any other sfa(e or local law re)ulatinp r.onslnrction a Iho <br /> pedonna�ce u!construction. Thaf I am authonzed Hy the mvner ol Nis property fo peAo�m the E I 3�� -• OZZ <br /> work!or vhich appl'cnfion is.maAe ond I tomply with Ihc Slafe Contraclors Law 1D.27 RCW and <br /> 296.200 WA <br /> i <br /> �, / l^ �% .. ' � � .J <br /> �-i l yipn Iu N- . ' � uale <br /> t <br /> REV�SEO S:G'1] <br />