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i -- - ---- --- -- <br /> � <br /> � <br /> ELECTRICAL PERM�T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857 –www.everettwa.org <br /> q�l� �e/G�Y�,� W�� <br /> PROJECT ADDRESS r�„�S— <br /> �rf�s�a�t ��r1iPs - a�6-/�,�'''5�:�..S�v �ios�Q , �v��el�, Wf1-9�� �s°-��< <br /> Owner �dailAddress City State2ip Phone <br /> ��S� <br /> �ifelti�es ��k�- ����u�d- /v:16- /��"5�s�r/�ios�A �1N�-9F2a� xd-7� <br /> � Tunan� Mait� C�ty � Statc2ip Phone <br /> %�if.-vice�'w��iG /iia=,So �k2oe,1"i4e�'R� S�i28 Wu.J� �',ujt'� 4,u-i '.7,99-�Hi T <br /> � EleciricalConiraetor MailAddress Ciry Slale2ip Phone <br /> ��rst'ft� ooi o � Uy a �6"6 <br /> Stale License Number(required) City of[verett Business License Number(required) <br /> �Omm o��a�/ ���i� 6'av�,�J <br /> Proposed Use of Building Coniract Price of Work <br /> �76Z� T�� t�/� k .�s�� •o��z <br /> Square Footage(If residenlial new construdion,remodel or addition) Conlacl Person/ConlaclJ umbedEmail <br /> Number of devices (If low vollage) <br /> Descriplion of Work lo Be Done: {�(�i t�� �"�M��� �rn���G�""' �'''-" � �r�G`� <br /> 9`/�{� rf� lL.�.�l — <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS J105 I � O � <br /> l <br /> I here6y cerfily fhaf 1 have read and examined fhis applicafion and know fhe same fo be t�ue and <br /> correcL �111 provisions ollaws and ordinances goveming fhis type o(work will be compfefed <br /> �vhefher speci�ed herein or noG Thc gran(ing of a permi(does nof p�esume lo give aufhonty lo PERMIT# <br /> violafo orcancel the provisions of any otherstate or locallaw regulating consfruction orfhe r I � I I _ O�-7 /, <br /> pedomiance of consfrucfion. Thaf 1 am aufhonzed by fhe ownerol fhis property to pedomi fhe C � \J <br /> work lorwhicft applicafion is made and I comply wifh the Sfate Confracfors Law 1827 RCW and <br /> 296.200 WAQ <br /> � �������" ��'�-� ��� <br /> � SignaWre Date <br /> REl'ISE�OH�06�OI1 <br />