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�— � �---- -- -- <br /> ELE TRlCAL PERMIT APPLICATION � <br /> C <br /> Cl�i Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br /> /// 3� �vC �2 G2c�, r,��- � <br /> PROJECT ADDRESS <br /> � ��i� �l a� � /�-�-. -t-u ���2�T l�l?2 Iz'ur,�rzc� !„a1 �(�12�r7' Gr/`1_ ��2 G </ I <br /> Owner fdail Adoress City � State2ip Phone I <br /> �1���7-`I33� <br /> Tenan� I�tatl Address Gty Stale/Z�p Phone <br /> / <br /> S �t/r?.vii� �i ��..,.. Sr�ii�z c� ,2��123 sF 3Sr°/" Y�u,��r,.��N l.t/!� lc�dJ7 _�G�'-3yeZZ�U <br /> [leclrical CoNractor J Wail 1lddress C�ly SIa1e2�p Phone <br /> Sylv�� LS � 3� L.1 a�}'(ie� ��I�' 15 _ <br /> State icense Number(required) Cily of Everetl Business License Number(required) <br /> 0 �G GU^L <br /> Proposed Use of�uildmg Contract Price of Work � <br /> ��e�T �nn/�-.��/� �Ob� J�/• ZZ�C I <br /> Square Footaye (If residential new conslruction, remodel or addiLon) Contact Person/Contact NumbedEmail <br /> Number of devices (If low voltage) <br /> Description of Work to De Done: /2,r,� �a-�� ��� �T%-� "T i �-�C�� (v � !� L �� "�� i, �. _ <br /> Y �� �_�� <br /> r <br /> < <�, ,�� a � ��� ti �l -- <br /> FE[ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 `/�� C <br /> 1 O Js <br /> {' <br /> 1 he�eby cerfily thal l have read and exarnined lhis applicalion and know Ihe same fo 6e true ano <br /> carrecf. All provis�ons ol/aws and ordinances gnveming(his type o/work will be completed <br /> whether speci(ed heiein or noL The granting o(a permi!does nof presume lo grve aulhonty fo PERMIT�I <br /> vielafe or cancel fhe provisions ol any o(herstare or�ocal law�egulating consfnicfion or fhe � <br /> peAomiance o/construc(ion. That I am authonzed by(he owner ol(his properiy to peAorm(he E I ,5� r .- D5 <br /> �vork/or'�vhich applica�ion is made and I cornply vnfh fhe Sta(e Contracfors Law 18.27 RCW and <br /> 296.200 VI�AC. <br /> ____��1 '7 �� �z ��� <br /> Signalur ' Date <br /> ae��seo oeiobaora � <br />