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� • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98��1 <br /> 425-257-8810 - FAX 425-257-8857 — www.everettwa.org ��a---�� <br /> G-14a�1—�� 7 <br /> Z 3 c I F�.,l -�n �J� <br /> PROJECT ADDRESS <br /> � <br /> �/1 ��h Q�I L a� ra� euT � z 3 i � F��l�v,� �.,� '� w� <br /> Owner MailAddress City Slate/Zip Ph�ne <br /> 5a-.�'le ctis �a.re_ <br /> Tenanl Mad Address Ciry SlaleRip Phone <br /> / `"l$!� ���'i�C � ZS23 5'� /�ve- ��`NSJi ��e- (..t�r9� yZS7(�01 Si� <br /> Elecirical Contractor Mail�ddress Cdy �p q $L7� Phone <br /> ��>�ri r-_ �D�io��[o0 <br /> State License Number (required) City of Everelt �usiness License Number(required) <br /> `� U7�1�. �v <br /> Proposed Use ol6widing Contract Price ol Work <br /> /��r�vwY��z�s �.�Y <br /> Square Footage pi residenlial new conslruction, remodel or addilion) Contact Person/Contact Numbed[mail <br /> �+�tw,-Ksouhlw,�d�(e�r���9 Nteti� �. C,�,�,, <br /> Number of devices pf low voltage) <br /> Description of Work �o Re Donc: ___ DQjl����_��n S � �/ � ��1 <br /> /-- � r � <br /> _rP�cL—._t¢a-�a-� ' � - <br /> J <br /> F[E <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �J � � <br /> 1 hereby cerhly fhnf I have road nnd examined Ihrs�PPlica6on and kno�v Ihe sarne fo be fnie and _ C <br /> r,onect. llUprovisions ollaws and aidinances govemmg�bis lype o/�vo�k ��nll be compleled <br /> whcihcr specilicd hercui or noL Thr, gronGng o/a pernid docs no(piesumc to give authonty to P[RMITt1 <br /> violate or cancel fhe provisians ol any olhrr sfa(e or local la�v mgulating consf�ucfion or fhe / <br /> pe�(om�ance oj corrs(n� n. That 1 ant aufhonzed Gy(he otvnerol fhis propc�ty to per/omr Ihe E f(.�O �/ �O O — <br /> work lor�vhi�/applic ior is made�nd I r,ompty wdh fbe 5(afe Confr�cfors Ww 18.27 RCW and � <br /> 296.200 A . <br /> � 1 � ' z -%�' <br /> 'ynatur / Uate <br /> nrw•:i'n oe.nr�mia <br />