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� � --i <br /> � <br /> ; ELECTRICAL PERMIT APPLICATIO�J <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -wv✓w.everettwa.org <br /> II <br /> � <br /> � <br /> G/7%v' �/���� l��✓J ��,� �i.z�/i�r�y�95' <br /> PROJECTADDRESS � <br /> �/a�r <br /> �� I��. i�i� �lr�'1� ./.�1���� �� -f�J G��s � �J <br /> , <br /> Ocir.er Matl�ddress City StatelLp Pno�:^_ <br /> I //1/� �i <br /> l� !�/G� �/�"����� !` <br /> ITenaM (AailAddress C�ty State/Lp Phone <br /> � i//�;,������- �r.� � ��,������� 9�3r �6�6�G�/5"� <br /> Electncal ontractor �dallAddress Gly StalelZip Phone <br /> �� <br /> � � /r> �i>;P �:�� 4 A �� ��S <br /> State License umber(required) City of Everefl Business L�cense Number(required) <br /> d� <br /> ! � .. �(�J '� <br /> ' /i�iil/1�G'✓�/�// <br /> i Proposed Use of Bwlding Contract Price ol Work <br /> ��� �(�)Sf.�J 'j�/�'l�/CS/��� <br /> Square Footage Qf residential new r.onstrud�on, remodel or addition) Con{act PerSoNContact Number/Emad <br /> Number of devices Qf low voltage) /J // / <br /> Descnption of Work �0 8c Done: ' '� �l`���� ��'' ' "JG' ' U � � "�(i � ' � <br /> �---,— <br /> FEE I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby ceitdy lhat 1 havc read and examined flris apG�ication and knmv fbe same fo be frue and <br /> correct. All provis�ons o/la�vs and ordinances goverriing fhis type olwork�vill be complefed <br /> �vhether speci�ed herein or not. The granling oI a pemul does not presume(0 9ive au(honty to P[RI�1Cf� <br /> violafe orcance/fhe prov�sions o/any ofhersfafr nrlocallaw�eg�dat�n_q consWc(ion orthe � I r �� ^ f �/ <br /> perfom�ance of consfruction. Thaf 1 am aufhonzed by the ownerol(his property to peAonn the (i I ��l <br /> wor�lor�vhich application is made and 1 comply�vifh fhe Stale Conlracfors La�v 18.27 RCVV and <br /> 296200 V✓AC. <br /> ������ ����� ��� <br /> SignaWre Datc <br /> G/l1�161r� c� (GY� ✓�S, -�j c��, vC 1/Cr �LlR �rG <br /> �F.v6EDG3Ga:01: _ _�_ . <br />