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ELECTRICAL PERIVIIT APPLICATION <br /> CIT� OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE[T, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �-�- 1� <br /> n � 1409�GSZ <br /> � 2v S ('�v�e !'�s N�.a vt Gt/a N <br /> PROJECT ADDRESS <br /> �r � ��., ��-�'�� �/-'�u S`3 S �✓P ci��" c.��� 9��5 �a� -��- 7 �� <br /> O�vner htail Address Gty Slate/Lp Pnone <br /> �S�-S �ZF� � C►''a�S I'�^u'�N .�/c%e� l.�3Y�- �1��/ yzSSiycbzy <br /> T�nant Mail Address Gly SlalelLp � Phone <br /> �eca �c�L 7 aox i�o`f6 7 �-f�� �-9$1c4�3 y36 .rz�xJ <br /> Electrical Conhactor Po1ail Address C�ly Stale2�p Phone <br /> 1�� �G� 5�-12V�11� oo y`� `�� <br /> Slate License Number(required) City of Everett Business License Number(reqwred) <br /> � /`l y9�( vc> <br /> ��-v-� � a FFr2e ��G`Le <br /> Proposed Use of Budding Conlract Pnce of Work <br /> <]�l� '��"Iy-�' �✓t,�r�'�'n'� <br /> Square Foolage"(I(residential new construchon, remodel or addNonj Contact Person/Conlact NumbedEmad <br /> � \ Z�l� 616 73SS- <br /> -T � <br /> Number of devices(I(low vollage) <br /> Description of Work to De Done: �� � �°V�P ""CQ--��� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX C06E IS J105 � /�� <br /> V <br /> I hereby certily lhaf I have read and examined this applicafion and know(he same to be true and <br /> co�recf. All provisions ollaws and ordinances goveming this fype o/work wi116e complefed <br /> �vhetherspecified herein or nof The granfing ol a pennif does not presume(o give authonty(o PERMIT# <br /> violate or cancel Ihe provisions ol any ofher sfafe or local la�v�egidafing consfniclion or(he r I � O /y �0� � <br /> peAormance ol consf�uclion. Thaf 1 am authonzed 6y fhe ownerol this property to peAomt the C `�� <br /> �voAc lor vdrich applicafion is made and I compty with the State Confraclors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � � ��� <br /> n ale <br /> FE�'ISED0805ROIJ _ __ . <br />