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I _ - � --- --- --� ------_ _ <br /> � ELECTRICAL PERMIT APPLICATION <br /> i CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810 - FAX 425-257-8857 — www.e��ereltwa.org � <br /> � <br /> ' �o�a0� �.�1M {'ln2,Vl�i�..� 17V``' ' <br /> 2 , <br /> � PROJECT ADDRESS �ZS ,7� 3 ��I <br /> i � <br /> T��M Qor�Wo� 660g CYSlhM�rC�Q`� v.� Ev�re�� �J � Gg2� <br /> !, Owner Ma1lAdtlress C�ty Statc�Z�p Phone <br /> Tenant Mad Address Gry Stale2p Phone I <br /> .L�� (���,-�k, ��ec�r« �(1u2S `�i`' c� SE L��-'c. �e�eNs �R�9�2.� y152'�`iC�61� <br /> i [leclrical Coniratlor Man Aedress Gry S�a;NLp Phone <br /> � ►, l�a,, �S ��z � q ,� 1 �41 ��5 �y�116� <br /> Slate License Number (required) V U City of[verett Business License Number(reqwred) <br /> �S1'✓�t,(P -�1� r ,�i, ��'e,���tnq j 7�C�•00 ; <br /> III Proposed Uke of Budding , _ CoNract Price ot Work I <br /> I �'a-I �r�l�. �zs yz �s��o�' 'I <br /> Square Footage(II residential new construction, mmodel or adddion) Contact Person/Contac� NumbedEmaii <br /> � <br /> � I <br /> I, Number of devices Qf low voltage) � <br /> Description of Work�0 8e Done: �(h J��` �� � W w i � 4�e�`��p �n� I <br /> I <br /> � <br /> I -- FEE I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 � � �,� <br /> � 1 hereGy certily lhat 16ave�ead and exammed this applicafion and kno�v fhe same to be true and <br /> � correct. All provrsions o/la�vs and ordinances goveming fhrs type olwork�:�ill be comp/eted �I <br /> Iwhefher spcu(eU hc�ein o�noL The g�anfing o!a permrt does not presume fo give authonty fo PERNIIT# <br /> violafe or cancel the provisions ol any othersfafe orlocalla�v regulafing consWcfion or the ^ � ` �� o�� <br /> perlormance o!consWction. That I am eufhonzed by the owner ol fhis property lo perform the C �J � <br /> work for�vhich app6cation is made and 1 comply wifh fhe Sfafe Confractors Law 1827 RCW and <br /> 296200 WAC <br /> � ���� y/ �/ !s <br /> Signatur Date <br /> � <br /> ' � <br /> nenseuo^;s�taia l <br />