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i — •. — <br /> ELECTRICAL PERMIT APPLICATION i <br /> ; CITY OF EVERETT PERMIT SERVICES ' <br /> i 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810 - FAX 425•257-8857 -www.everettwa.org <br /> I I <br /> I <br /> S7/(��VE�ZG��r�( Cv-9 `/ II <br /> ' i PROJECT ADDRESS <br /> ; l�tV��l�9.�0Cn��ACeoN��/OSds'NF /S,?"'S� �j'dr//FL ✓✓� 9�0�/ z�,-s��-za7� <br /> � Own¢r Ma�l Atl�ress Gry Stalc2�p Pnonc <br /> i <br /> I <br /> i <br /> ILorh za,�� .5�f�,�tir�zra�ui,etir /c333 ,0�,�,z�t,e✓��/ S�TCF IJ9- 9�133 Z��->ec-2o� _ <br /> I Tenant rdai�ncaress Ciry Stale2ip Phone <br /> � .Sic,�M.�k� /S�SFit�v✓�y i�� �A /�9rdE,z�-�,� t�la 4BZ�3 �r0-�(2fi-y�5 <br /> I ElBclncal COntraCtOr I:�ad Aderess CRy Stale4ip Phore <br /> F ct S1 G'�.(M L L 9,��R.i � /� /�I� D7� <br /> Slate L�cenSe Number �onlract Pnce of Work <br /> ii /AT21[.1- I�O �J,4 <br /> i t�rrlihfr2c�/�C�i2�T.�/L_ <br /> � Proposed Use of Buildin Contact Person (Plan Rewew) <br /> � <br /> i !�— I <br /> � Square Footage(If res��denUal new construchon, remodel or addition) I <br /> �� I <br /> Number of devices pf low voltage) I <br /> Descnplion of Work to Be Done. .�, -5 i/1C.L_ C�J G(/Ff(.L .S���� , __ <br /> I - — _— <br /> � <br /> FEE ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� <br /> ;hereby ce�tJy fhal 1 have read and eaammed lhis t�pplicatrcn and know fhe samo to be We and <br /> conocf. All piov�srons of laws and ordinanCos govommg lhis type ol wo�k wdl be cornpletod � <br /> �vhe(her spec!lic�d herem or noL The g2nfing ol e peimit tloer nor presumo to give authonty fo PERMIT# <br /> violale or c�ncel fhe prowsiens o/any other sfule or local lacv regulafing conslrucbon or fhe !�/ �7 <br /> pedomiance o(construcfion. Thef I am aulhon:od by fhe ownor of 7his property to pedorm fhe E � ����7 — 2�� / <br /> work lor which Iicalion is mado and I compty wifh fho Srofe Confracfors Lnvi 78.27 RCW and <br /> 296 200 WA <br /> . ��i� ��?�'/ <br /> I Src� ur Date <br /> F�✓i5E01:GiJ <br />