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03-25-10:03:53PA1: <br />:]063G32900 ff 1/ 1 <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 - www.everettwa.org <br />77oS C—��- rc�� (.-� Su.i�'� � al`� <br />PROJECT ADDRESS ��e�� �� �f 9 K'� 3 <br />j�GOlv..n..plc� Ccv"�c.�2 /YIc�2G I�O�t)'�T `/vSjD �San �—X��• J TX Z8Z?`( <br />Ownef hlail �ddress Ci1y Slate2lp Phane <br />K�rQ G �l�f' <br />Ciiy <br />SIatC21p Phone <br />/�i l �I�� e.. �o�..-_�,.1�,..kr �.s 3c� ,cJ r y�S�. .�s�-�.��'W,� `��r33 ��)�63 -3c <br />EleclncalConlraclor MallAddress Cily Slala2lp Phone <br />���r�l+cz D�L�-1 <br />State License Num6er (required) <br />,lSQ—rw. � <br />Proposed Use of Building <br />X �ar `E''�g <br />� Square Foolage Qf residential rew consl�vction, remodel or addilion) <br />� Numh1 o�evices(Iflowvoitage) <br />�escription of Work to Be Done: <br />o� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />� 5 � � '2r� <br />City of Everett Business Licanse Num6er (required) <br />Contract Price of Work <br />(�e.9. "L�a.t�,�,,�,..-�- �'?�6� 36 3 -31� <br />Conlact Personl nlaG NumhedEm il <br />��Q�..lcp��se ��C <br />I horoby cc�fify lhal I havo �ead and examinod fhis app/ication and know Ihe samz lo be frus and <br />correcf. All provisions olfa�vs and ordinances goveminq �his fype o/work will ba completed <br />ivhelhe� speci(ed hemin ornof. The granfing of a pormif does no( prosumo to givc aufhoiily (o <br />violafo orcancel (hc provisions o/any ofhersfa(o orlocal lawregulafing consfrucfion ortha <br />pen�nnance olconst�uclion. Thaf I am aufhorizad by Ihe o�n�ner of fhis property fo parform (he <br />work lor which application is made and I comp/y witfr Iho State Contractors La�v 18.27 RCW and <br />296.200 WAC. � <br />�nseooaanoia <br />FEE <br />-�`� �O <br />�lt� <br />PERMIT# <br />�'���-�`�$ <br />