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---- --- -- <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> Iq25•257-8810 - FAX 425-257-8857 - www everettwa.org <br /> � <br /> Ii I �R02 � V�Q 6QEkr� L✓i�Y #l� - <br /> � PROJECT ADDRESS <br /> � <br /> x Earnc wA 98t vZ ___— <br /> � �(���16E 33 ��meaTl�S 74SReL�¢vu� Alk . lo s�a�erz�, Phonc <br /> I �dad Fdtlress City <br /> O,vner <br /> � _unv'�la-( �'v�n�A 9B1��1 4�_— s 'k'a'��o <br /> i JI)ST� S/11LC l�iclJifa(_ �'r�Q�._��C-�ab�N City State�t�p an��r <br /> I Mail Fdoress <br /> i Tenant <br /> �(✓/1 Cl S L L'67I' 7 <br /> '76G b�p n,�.•� n v F � � "''` Phone <br /> 'I iGNs A.�s c�iv s„ie¢�P <br /> Electncal Contrector raa�i Address <br /> ' GD`� <br /> '� n !� 11-� <br /> i <br /> �6/..>S r� l S Contraq Pnce of Work <br /> !� State License Number <br /> iH�l�e L��+£dR/�+K�r16ui�S-- <br /> i <br /> �, /�fbi[q� Contact Person (Plan Review) <br /> �� Proposed Use of�udd�ng <br /> i <br /> � J4�U <br /> i <br /> �I <br /> �quare Footage (If residential new cunstruc;ion, remodel or addiuon� <br /> il <br /> i <br /> � Number of dewces(Ii low voltage) <br /> i <br /> i �.n��z L�'rt�2S ;�(1��0 _ <br /> � =NSTA�` ON� S6'"r OC ��4 <br /> j DescripUon o(Work to Be Done <br /> i <br /> il <br /> I — <br /> I <br /> I <br /> IFEE <br /> ; 50�� <br /> � I - <br /> � CITY OP EVERETT LOCAL SAlES TAX CODE IS 9105 <br /> II hereby ceRiiy thaf�liave mad and e���mined fhrs apP�icnfion and kno�+•fhe same fo be frue and L�_----- <br /> conecL All p�ovisions of la�vs and ordinances Oovemmg fhis e O(work wd�be completcd <br /> whelher specifiad hcrein o�not. Thc granfing of a permd es r f presurne fo give aufhont7�fo PERI y o g / D�� <br /> violate or cancel the provisions o(any olher state or I al law 9ulahng consWcfion or the r <br /> perlamanr,e ol cansWchon. Thai I am a on edth fhe� feAConf ac os��rt+' �8 27 ftCW and C <br /> work !or wbrch appDcahon is made an com y <br /> I 296.200 WAC. <br /> 8 ,r .Z 0/U <br /> Date <br /> ISigndWrC <br /> ir.FrrscDa?n:�— _._.____—___�---—-- —--- — —_---- <br /> L <br />