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� <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257•8857 — w�w�.everettwa.org <br />Unl� C <br />6 �jo�j �uGrz�ru�� ��-y �i��2o3 <br />PROJECT ADDRESS <br />o�•�,�� M (vG I,I,G <br />Q�'v R��,uvs�, � <br />Tenant <br />[leclrical CoMractor <br />FAad Address <br />r:lait <br />Mali Atltlress <br />C�o��y �� - �� � pG( <br />State License IJumber (reqwred) <br />T T <br />Proposed Use of �uilding <br />l��v <br />Square Footage Qf residen�ial new construction, remodel or addilion) <br />Number of devices (If low voitage) <br />City <br />Ci�y <br />SWte2�p <br />� V��il� � <br />SlatelZip <br />� ��� <br />S:ate2ip <br />Phcne <br />Pncne <br />s�z�_y__ <br />Phcne <br />C-( Z,S�- (a 7 i- �> <br />ap�lied �- iof 31��{ <br />City of Everett Business License NumbT er (reqwred) <br />6 UQ • C�O <br />onlracl Price o( Work <br />C` �� ��-G�l2S0 r�� <br />,r_. <br />Contact PersonlConlact NumbedEmail <br />L;� �A/l��2 ��¢L E[,�2r�L�L. <br />Gj Go�� �-CJ/W+4 i=✓1 C.iJ�� -r�. C.v'�l <br />(�escription of �Vork �o Bc Done: ���� ��-� 5���� ""��'�'Uy/ S ��� <br />��na _t;��S�/�.7C... C.�"2c��-S �o �'L- iV,� � --- <br />�7 � N /�-� <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I he�eby cerlily (hat I have read and examined this applicalion and knmvlh� sarne (o be ln�e and <br />correcl. All provisions ollaws and ordinances goveming (his type ol wo�lr will be complefed <br />u�hetherspecdied herein ornoL The granfing ol a pennit does nof presumc to give authonty to <br />violate or cancel fhe provisions o/ any ofher s(afe or local law regulafing consfniction or the <br />peAwmance ol conshuclion. That I am authonzed by fhe o�vnerol fnis property to perform the <br />ivork lor which application is rnade and I comply wifh Ihe Sta(e Contiactors La�v 18.27 RCW and <br />REVISFD C9u6401J <br />FEE <br />Zfzao <br />PERMIT�� <br />Eiy�O -oz7 <br />