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! ELECTRICAL PERMIT APPLICATION ,I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820 i <br /> 425-257-8810 - FAX425-257-8857—www.everettwa.org <br /> I <br /> � ga 5 � <br /> G � so9-aa3 j <br /> Z$�� C�I I�., l�v� ��3d.� E,,�- l,��- �18�y q. �o _�s <br /> PROJECT ADDRE S � <br /> IOwnef htad Aadress <br /> I C��Y Statc2iP Phone <br /> S��t�3C3t� <br /> Tr;�_�� I;kl � Zu 31_.��1�► y_�9-y� �,ro.,�ff w�- q8u�'y <br /> Tenant n�a:i naa�e s Gry Sia�erLv Pnnne <br /> W�LJ,�._-,� L.41'L 4....n� Iq6� S� 1/-��- 41,�148032 L.�mi )y3G-Lrs� il <br /> E�ectnca�CoHtractoF �.�ae,aea�ess ' I <br /> Qry StatciLP Phone <br /> ���YV1 '�'x ��1f'V� t�e� I�7 � <br /> State License Number Conlracl Price of Work <br /> � I�YZr.,, I�r1I.�.4Au� � <br /> Proposed Use of Building Contact Person (Plan Review) � <br /> Square Footage(If residential new conslruction, remoCel or addition) I <br /> � <br /> Number of devices(If law voltagc) <br /> Descriplion of Work lo Bc Donc, YU�)� [L,.�L .kv,r y�C�.SJ QL�S S �o v��}-yty�� C �t/� � � r� <br /> _Lobl.�y dcs�s v �,r,ti, I u' Fl� P�-1 <br /> FEE I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � o O � , <br /> I hereby ccrtAy lhal I have rcad and e.rammed fhrs a p plicoLon and kno�v the s am e f o 6 e f r u e a n d � __l <br /> cormct. A/l provisons ollaws and ordmances govemmg this tyoe u/�vork wdl be complefeA — � <br /> whethcr spec�(ed herem or nof The grannng ol a permd does no7 pmsume fo give aufhonty to pERMIT# <br /> �o�a(e or cancel flre provisions ol any other sfafe or loca!law mgulafmg co:u�niclion or fhe � �� , n���� <br /> erformance ol ronsWclion. Thaf 1 anr aulhonzed by(he owner oI this property fo pedomi fhe V�I <br /> wo�k lor wh�ch applica(ron is made anQ I c�mply with the S(afe Contraclors Law 78 27 RCW and <br /> 296 AC. ^ G� n�J <br /> ��J � ��/ � 2��5 <br /> 9gnature Date <br /> FC�YS!!)1]iY17 <br />