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� <br /> ELECT�AL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.gov <br /> �' � �S//-o y� <br /> � �9� � C'� L�„ A��eti�c� //-'9-/S <br /> PROJECT ADDRESS <br /> T{-.� l'.�' �hmc��.) }�c�h <br /> Owner Ma�l Aadress Crty Stale2ip Phone <br /> -Ka5- 5oJ- <br /> �9�3 �,•U�v Ac��ei�ve F ���rP1{� t� a 9P �nT��aq <br /> T8n0nl Mall Adaress C�Iy Slate2ip Phone <br /> �r�S r�, yc �Zn�C Sv�4eH <br /> cJ I �.� �� � 19 � i5- �. �'A�i� l�y L�a��..�ooc� (.JA 98c13(� <br /> Elecirical CoNractor h9ai�ndaress Gry Stafe2�,p Phone <br /> M12ELEE C7890 aC' o � i5 �[ <br /> State license Number(reqwred) City of Everelt Business License Number(required) <br /> �'Q V�r n� <br /> . �'la`�� C� <br /> -P+e�e9edUse o'E3uilding Contract Price o1 Work <br /> '�,.� — �v��' <br /> --- �o�L LL� mcz�J-- ���.�4 <br /> Square Footage(II residenlial new construction, remodel or adddion) Contact Person/Conlact NumbedEmail <br /> Number of devices (II low vollage) <br /> Descriplion oI W.ork to Be Donc: Q/�( c�� �/�"In C� rC U � '+' �i-n r YILE✓'J t�11i r� �'��� <br /> �ar,��D Foo�3 Drnn �' �chNn� c2vwrL <br /> fEE <br /> 7� <br /> CITY OF EVERET7 LOCAL SALES TAX CODE IS 3105 �fi L�I� <br /> I here6y certAy Ihat 1 have read and examined lhis applicafion and know fhe same lo be frue and <br /> conecL All provisions o/laws and ordinances govemmg Ihrs type o!work will be completed <br /> whether speci�ed herein or noL The granUng oI a permif does not presume fo give aufhonty to PERMIT# <br /> woiafe or cancel fhe provisions o!any other stafe or local law regulafing consfruclion or fhe � �`��� �� <br /> pedom�ance o/cons�rucfion. That I am authonzed by Ihe owner ol fhis property(o perform Ihe ,� <br /> work lor which appGca(ion is made and I comply wilh fhe State Contracrors Law 08.27 RCW and <br /> • 296 200 WAC.� <br /> l <br /> ��¢�, ��.D �C� <br /> ,�� rnAs ��-�9- ao � <br /> � Signature t �a�e <br /> REV4E0 od J6^.0 ia <br />