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EL�CTRiCAL PERMlT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERGTT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�,��� Cve2�1�L22_�1 �ur�G lv Cve�eG�� �d� <br />PROJECT ADDRESS <br />(lladr'nfl� �i,-id2� -- <br />Owner idailAddress C�ly Slale/Zip <br />f'Ihone <br />Uladr'M,K �i��d�-� <br />Tenanl Ma�lAtldress Gty Statc2ip Phonc <br />I�RNAS f/ecf�cc GLc ab�a� �i��-�AvEst �kt w.� qSo30 <br />EledricalCoNractor tdailACdress City Slate2ip Phone <br />PANAs�� Sb�RN <br />State License Number (required) City o( Everett Business License Number (required) <br />NoMe �(oo,� ���odel�. ��uNo(�oo.00 <br />Proposed Use o( �uilding Conirad Price ef Work <br />Square Foolage Qf residential new construction, remodel or addilion) <br />Number of devices (If law voltage) <br />V�ae�in��.�l�. (L�'� 3r4- 6z �Z <br />Contact PersoNCentacl NumberlEmail <br />Destriptiono`WorktoBeCone: CODthP(-� �w0 P�PG�/<Qr ��`��� <br />CIT( OF �VERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily Ihaf I have read and ex;�mined fbis applica(ion and know the same fo be frae and <br />conecL All provisions o/laws and ordinances goveming fhis lype o/ �vork will Ge completed <br />whefherspecified hercin ornoL The granlinp of a pennif does no( presume to give aulhonty to <br />violafe or cancel the provisions oI any others(afe orlocal lav� �egulafin9 cons6uction or Ihe <br />pedoimance ol cons(ruc(ion. That I am aulhonzed by the o�merol (his propeity to perfomi fhe <br />work for which application is made and I comply wi(h fhe Sfafe Contncfors Law 18.27 RCW and <br />296.200 W�C. <br />/� <br />irew ceo aavw.me <br />FEE <br />� �D� �° <br />PERh1IT,". <br />E 15ob-ll2 <br />