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09/23/201a xue 9� 41 eaX 0002/002 <br /> • • <br /> ELECTRICAL pERMIT AP�°LICATION <br /> CITY OF EVERETT PERMIT SERVICE5 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-885T —www.evaretlwa.org <br /> �1�-a-3-�� <br /> C— iu�o�-�� <br /> 5.�0 6 -�v�:� � <br /> PROJECT ADDRE98 <br /> �� �-a�J� 510� �v�esf` � � W 1� �i�b�a '3 <br /> Owner Mnll Addrese —� Clly StOtnl2lp Phonn <br /> � <br /> Tenent Mell Addreee Cily Stole2ip Phone <br /> EL'D �4,7-5) 1�� �.}�B <br /> �Iat�+o+�..c a.�.,�nmr.+ca1-.e„ I�15DI[u�h 7a0y N� I�-!'� l'J� MC�v�cl W'� q��.3� <br /> Eletldonl Conirecto� MeU Acldr ee Clty SlxlelZip Phone <br /> E.i-��T C'D ��Iq 5 N <br /> Stste Llconna Numhor(roqulrod) Clly af Everett Bueiness Llconeo Numhor(roqulrod) <br /> �xrr��ti 'i�S �S � �o�° � a�° <br /> Propoaed Uee of uilding , Gnntrnd Prlco of Work <br /> � � � ��� <br /> Squere Footege Qf residential new conet�uctlan,rwmadxl or eddltlon) Cnntact PoreonlContad NumberlEmall <br /> Numbor of devlcaa(If low vollagn) <br /> Doacrlptlon of Wark W Be Donu: {l�tn.� �f�0- �ALq�,� V�'A i"` J\� ` ��'�� <br /> �`� S ' ec� -f I ' S°/e r S�'� 7' SO r- l� ;L' Sb <br /> FEE <br /> cITY OF EVEREtt LOCAL 8ALE9 TAX CODE 19 310b ��` �� S� <br /> li' <br /> I horoby corlly fhat I hovo roud and oxominod fhfa eypllcatlon and know fiir same to be trup ond <br /> cur�ecf. All piovlsfons ollews end ordlnences poverning thls type ol tvorN w1116o complotod <br /> whnlherapeclM1'ed hernln or not. Tho gronflnp afa pormlf dovA notp�es�me fo plvn eufhwlly fo PERMIT� <br /> vlolafo or cencel!hr provfsians ol any o(her stefu or local Inw repuleflnp conafrucflnn or tho � I �. O C�_ I � I <br /> peAormencn o/consln�cffort. Tbnt I om oulhoAzod by fhe owner ol fhla propeRy(o perform f1�e � <br /> work/nr whlch app nNon Is made and 1 comply wlth fhe S(ate Cantrectora Law 10.27 RCW and <br /> 296.200 WAC. <br /> �_.___... 9 �3 J <br /> A� 1 n� <br /> /+N�SfO ONCL701� <br />