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� <br /> � ELE TRICAL pERMI ICA�ION <br /> C T APPL <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-88�7 —www.everettwa.org <br /> � <br /> �si 4 ���, �., j <br /> ?ROJECT ADDRESS I <br /> � <br /> Ownet �da�I AdCress G.ty StateZip Phor.a i <br /> IA � -z� <br /> Tenant RledAdaross CRy SUte2�p Phono <br /> ' ��.��--/ "�`��LYnn t.w o.l l�A� S�o��-a. �� <br /> Ele Intal ontr8c r �daJ Adar ss C4y Slatcl �D Prone <br /> SD��S � C)��9 <br /> Siate Licen e Num er(re wretl�� Ciry of Evemtt Business License Number(reCuired) <br /> t <br /> _ i <br /> Proposed Use of Budding Conlract Pnco ol Work � <br /> Square Footaga p(resident�al now construction,�emodel or addilion) Conlact PersoNContact Number/Email <br /> Numbor ol devitos Qf low vollage) <br /> Description of Work lo Be Done: �l�A,� � C�1'�I ��r ✓S �/L�n('Pf�YA__� <br /> �y'�— <br /> ; FEE <br /> � CITY OF EVERETT LOCAL SALES TAJ(CODE IS 3105 � T �� <br /> � �) <br /> '' I hereby cortily thot 1 havo roed and oxomined fha epplrcation and know fhe sema fc be true end <br /> � covoct. All piovisions ollaws and ordinences goveming fhis type ol work wdl be complaf�d <br /> � whother spoci(ed harem or not The granfing of a permrt does not presumo to givo aulhonty fo PERMITk <br /> violafe or cancol fho provisrons o!any othor stalo or local law rngWeting construc��on or�he �S� <br /> j peAo�nanco ol construcfion. Thaf 1 am eufhonzad by fhe owner ol fhis property to pedo�m fho E (�� � <br /> iwork lor which appliceGon is made and 1 comply with the Stafe Con(2c(ors Law 7 0.:�RC W end <br /> , 296200 WAC. <br /> ' L�--��!'�/� ��/�S/ �� I <br /> ' Signaturo Oate ; <br /> I <br /> � wEl'�SFDOS�Ri0+1 I <br /> � _._.____— ___"_ _'__._'_'— _� <br />