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� � <br /> � -- — ------ <br /> �� � <br /> i ELEGTRICAL PEFtMIT APPLICATION <br /> i CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> i <br /> ; 425-257-88t0 - FAX425-257-8857 —www.everettwa.org I <br /> I � <br /> I I <br /> I <br /> i _ �0203 SE �Uere{-�' fl'lc�l� WaU �� I <br /> PROJECT ADDRESS I <br /> ��q B�o�t ,-A���. � a�l sw �'� !�„�, �"1`�`l� Por+laN� D� 93�oy (,�3�Y��-'�'�o <br /> i Ownef Ida:l Add�ess Ciry Stale2ip PhGne <br /> � So�e Per('ec,{��o,l S�lozs le?o3 sE cv /�1�lI tJAy �i�U�.t� W� q����� <br /> � Tenant hlaiiAadress —� Ciry Stalel2ip Phone <br /> � I <br /> i �err sr � s sf�� 3Yao Na�l�so� (�.�- �J��e-rt Wirq�ao3 �y� 3�6 ��3s � <br /> ElecViCal ontracto� Maii Address Ciry Slale2ip Pho�e I <br /> � 6i%(�yNca85 �3 oaY�6 I <br /> IState License Number(requ•red) City o1 Everett Business License Number(ieQuired) I <br /> I ��°° � <br /> � Proposed Use of Bwldinq Contrect Price of Work <br /> C��,e�Sa,A �S (Y�� ��s ���s <br /> I Square Footage(II residential new conslruction,remodel or addition) Comact PersonlConlact NumbedEmail <br /> I <br /> � Number of devices(1!low vollage) <br /> I <br /> Description of Work to Be Done: _�f W F— u� p oue,� 1 U S��4L - <br /> FEE <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 /�OVi <br /> �� <br /> 1 heroby cert�ly Ihaf I have reaAand examined this applica(ion and know fhe samo fo be huo and <br /> conact. All provisions ollaws and ortlinancos govoming fhis type o/work will bo complotod <br /> whefher specified herein or noL fho gianfing ola permit doos nof presume to givo au(honty lo PERMIT# <br /> violate or cancel fhe provisions ol any olhar s(ate or local law regu/ating conshuclion or the <br /> IpoAormance ol consfruction. Thal I am aulhorizod by(he Owner ol this property(o porlorm fho E ' ��D —/� <br /> Iwork lor which applicalion is made and I comply wilb fho Stafe Confraclors Law 1827 RCW and <br /> I 29G200 WAC. <br /> �5,���,�-�- ���ayl�y <br /> ISignature Date <br /> aEVI5Eo089620�a <br />