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� TR�ICAL PERMIT AP•ICATIQN <br /> ELEC <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -wv,nri.everettwa.org <br /> c� sod-�o3 <br /> yC 6/6-/S� <br /> / J/01 �,Ow/�c../Q ,��e- <br /> PROJECTADDRESS <br /> ��/'i /,J G, ' �C 1 S D l I c�.n� .Cf.�%!� ,oW� �J��'-7T LJh • p�Za j �/�- <br /> Owner Mail Atldress City :'atelZip Phone <br /> Tenant �daii Address ' City SlarelZip Phone <br /> 3Ga � <br /> l.�J�-S��n �L��'�r d/r /� �'J�i�. �v,E ��✓`�tis,�ir.�.r x,✓,G 9627a r �i -�L <br /> EleclricalContractor MailAddress Ciry State2ip Phone <br /> ;� ,�.1 �J� � 7� 1 <br /> S�le L�i en�se Number(required) City of Ever?tt Business License Number(required) <br /> r_ <br /> 3�� <br /> iProposed Use of Building Contract P�ice o`Work <br /> �-r� - �11-5 S�9 -a v 7� <br /> Square Footage Qf residential new construclion, remodel or addition) Contact Person/Contact NumbedEmail <br /> Number of devices (If lov+voltage) <br /> Description o(Work to Be Done �'�D ���w� V�u-u�' �'J Z�w' � <br /> FEE <br /> CITY OF EVERETT LOCAL SAlES TAX CODE IS 3105 �0 O�L <br /> 1 hereby ceRJy(haf I have read and examined this application and know fhe same(c be (�ve and <br /> correcf. All provisions ollaws and ordinances goveming fhis fype ol worN will be completed <br /> �vhefher specified herein or not. The granfing ol a penuit does nof oresume b give aufho�ity fo PERMIl'tl <br /> violafe or cancel the provisions oI any other state or local!ow rngulating conslruc(ion or fhe ^ <br /> perlormance oI consfn�ction. Thaf 1 am au�horized by(he o�ner o/fhis properiy to pedonn Ihe t ��Or„— I� <br /> �vod<lor which applicalion is made and I comply wi(h(he S(ate Cont�actors Law 18.27 RCW and v� <br /> 296100 WAC. <br /> �'L� � / � "�� —�� <br /> Signature Date <br /> Rc`VISE008/a5401J <br />