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� - - - � --- - - ----- -- _w <br />ELECT�ICAL PERMiT APPLICA�'ION <br />CITY C)F EVERI�TT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, lNA 98201 <br />� 425-257-8810 - FAX 425-257-8857 - www.everettwa.gov <br />6/�l/-02� <br />' I 77 sc� 5'F �vziltl- ltilu(l c.x��L �- --� � I--� 2_ls I <br />� <br />� <br />PROJECT ADDRESS I <br />' 7o�,c 12 U< � �,Fc*�i'vey�,x.�v i,Jrxr,,�_— N� o7'i7o _ I <br />�� Owner Mal�dtlress � C�ty�� Slate�Z�p Ph„ne � <br />� l"u�t !2 Us i374,S����- ' i=�zrefl �A q�� �f 2S- 3S 3-fi�9�' <br />ITenant �dad AGdress Cuy State�Zip Phone <br />� ci.,,,�.,... -n�m_.,...,., i�. ���e. ��___ OL ate ni........ ..,G. 9xroi.� ¢l�n.�C4-�lS�/Z <br />Elecincal <br />tAatl Aadress <br />Slale/Zi0 Phone <br />�I SHcc�1��q3Sk� mSyQSS% <br />�, State License Number (reqwred) Cdy o( Evere�t Business license Number (reqwretl) <br />�PZ�O�.DO <br />� Proposed Use of Oudtlmg Contract Pnce of Work <br />' Square Footage (If res�den�ial new construction, remodel or addiUon) <br />Number of dev�ces pf Icw voltage) <br />Descript�on of Work to Oe D�ne /' �lu /� <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />CI JW i * <br />Centaa PersonlCoNacl N�mbeNEmail <br />I hereby cerL/y fhal I havr� read and exammeU (his app6cahon and kno�v7he same fo be fnie r+nd <br />conac( All provisions ol laws and o�dinances govemmg Ihis type o/ wa�k �vJl Go complalad <br />who(hoi specdiod herein or nol The granfmg ol a pemiit ooes nof presume fo give aufhoriry fo <br />violafe or cancel fhe provisions ol any ofhe� sfa(e o� local Imv regulafmg conSLucfion or Ihe <br />performanco o/ consfn�cf�on Tha( i am aufhunzed Ly fhe owne� ollhis property fo peAorm Iho <br />work lor which applicafion is made anJ I comply wdh the Sfate Contracto�s Lau� 18.27 RCW and <br />296200 WAC. � <br />I ��-w1�t,vLf/ V <br />� <br />i Signature <br />_3,-�s: 0 c� ��so i: <br />FEE <br />d� I b2 .�o <br />�PERMIT?t � <br />I�1 1 � �D <br />