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ELECTRICAL PERMIT APPLICATION <br /> j CITY OF EVERETT PERMfT SERVICES <br /> ; 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �I 425-257-8810 - FAX 425-257-8857 -�wvw.everettwa.gov <br /> I <br /> I <br /> � <br /> ' 1C �I2�ti � � P �:�i e�' -, (.�.'r.,( _ L.� : � '� - C� Pr� � �, (ti�;` . �l�i 20'� <br /> i <br /> I PROJECT ADDRESS <br /> ! ^ �-�[5)2 S9 - <br /> � J��cr��.. �ari�, ; fC�`11�f C,,p,�,�o:,, �,��,., �� i�: r � � C���1 - �(G��-� �i>�f4 <br /> I O�mer PSaii Adtlress (!,��,4 _ ,.� Gty StatelCip Phone �� <br /> i <br /> I ' l ' ) 1 l� � I �� <br /> ' TenBni 4dad ACdress City State/Zip Phone II <br /> i GJy�.+ ;- C I ,�� + ; � �. <br /> (_.i'•\Lt ��.:.� t0�� Ul.�.. �J. L� . I�)Oa. � '1 '�l� ( ..:-���, .. , �`(' l �'. � I`. (,�.;�1-� �I J �4JL �iC�'�}'i'1 '(.C•4- I <br /> � Flectrical Coniractor ldatl Atltlress Ciry StatelZip Phone I <br /> , � . • <br /> � ,� ;��;��r« �--�;-r �� � �_ ��� =� �� � , <br /> � <br /> Stale License Number (required) Ciry of Everett Ousiness License Number(2quired) II <br /> � ��3��} ��c. �e� i <br /> I Proposed Use of Ou,lding Contratt Price of Work : <br /> , 1.����, �c� <br /> lti� ��n_I-f ���ycr��� rl�c•Ir �c�_ ��'�rh�_;(.coei�� <br /> j Square Footage (If resideNial new consfruction, remoclel or adtlilion) Contact PersoNCon ct NumbedEmail I <br /> i i <br /> � ; <br /> � ' I <br /> � � — � <br /> �- Number of devices (If low volt2ge) I <br /> I� 7 �I <br /> � Oescriptian of VVark lo Be Done� ' t'`.C�Yi�0.� f�' �� l� K � �'I �� � r• w ll ��D S 'I�� F�r�••�"':.-' l�^ , �i II <br /> i �_ I t �� nI � : <br /> 0 .�\ S{�\�I '-t^ t'Il�ov l'J�1 �'7�i� �\('("f '1r•;> C �^. ��' '� _ — I <br /> I I <br /> I <br /> FEE I <br /> � � ���,`�D <br /> CITY OF EVERE'fT LOCAL SALES TAX CODE IS 3105 <br /> i ✓ <br /> � 1 he�eUy ceRily that I have read and examined this application and kno�v the same!o be lrue and <br /> correcL A(1 provisions o(laws and ordinances goveming fhis type o(wo�k�vill be completed <br /> whether specified herein or not The granfing ol a permit does not pmsume to givc aufhority to PERh1IT# <br /> violate orcancel the provlsions ol any oMer stafe oi local law regulating conSVuction or the � I ��� _ �� <br /> peAormance of consfruction That I am authorized by the ownerol this pioperty to peAorm fhe <br /> �vorh(or which application is made and f comply with the Stare Cont2crors Law 18.27 RCW and <br /> 296 200 WAC. <br /> � ���1 �' 1_G[. �^,� �, �' � � <br /> , . i�n:: Cch �C- �� I �� I <br /> " SignaWre ` Date <br /> I He;vsr:�cyvaao�. .---- <br />