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EL�CTRICAL �ERMIT AP4�LICATION <br />CITY OF EVERE'fT PERMIT SERVICES <br />3200 CEDAR STR[ET, EVERE7T, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvnv.everettwa org <br />��D D_ �_�f P Prl �,:�1( �/ <br />PROJECT ADDRE�S-T <br />� �o�O1�iL��L�S1�1iV,�. PI u7�i LL(. PU &��_9��0. �c�� Ar���i� , 1 X i�6���1 <br />� Owner M11a�l Address Cdy StateiLp Phone <br />I �� <br />i Tenanl <br />I Eiectr <br />t.tad <br />Address <br />ME� ��I )i ��I <br />5!ate icerse Number (reqmred� <br />�lj�i1(��InU i1..v �ilihG�L .IG�S Si�'}<vl <br />Proposed Us o( Budding <br />I Square Footage (I( resiCent��l new construction, remotlel or addAion) <br />Nu ber of dev�ces Qf low voltage) <br />Descr�pUon of Work to Re Done <br />c�tn� �Xi sfi � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />C�Iy <br />5 <br />Sta'e/Zip <br />SlatelZio <br />PhG�e <br />3uc� � H 1�i - �3 �-s <br />� u�i 9��13 <br />l PhC�e <br />�',SSOS�j <br />Ciry oi Everett Busir.ess License Number �reycired� <br />_��-D o. DO <br />Contract Pr�ce o! Work <br />1 �� � <br />��i1i� II`f,I'11ia15 0- yN-i3 <br />Con1aC PersonlContact NumbedEmad <br />Si��EUn,t�����1��Cf5'� �N.Co�vl <br />I horoby cortJy thaf I have ioad anAex�mmr.d fhis apphcation and Anow fho s�im� 1� ho Irue and <br />co�rocl All pravisions of laws and arAmancos govornm,q fhis typo o! work �vill bn cornplefod <br />�t�ho(hor spoufiod horam or nof Thn granlmg o! a pomut docs nol presumo lo grvo aulhr,nry fo <br />violnfo or cancol Ihc provrsions o/any ofhor sfato or /ocal /aw rog�Jating consfniclion or Iho <br />porfoimance ol consfn�chon. Thaf I arn aufhonzed by fhe ownar o/ (his propr. r7y to porlomr fho <br />�vuM lor whlch applicaliun rs nmdc and I cnmply �tvllr fho Stalo Carfracto�s Law 18.27 RCW and <br />296.200 WAC. <br />rrE P�SEn useSC')': <br />FEE <br />� D°' <br />PERMR# <br />E ��p� — pc�a— <br />