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ELECT�ICAL PERIV�IT APF'-�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> °200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 475-257-8857 —�+nvw.everettwa,org <br /> � �- a-r7--15� <br /> �� / .����<-�( l� v <br /> � 15 o i--/�7 <br /> PROJ�CT ADDRESS <br /> �� - / � �y <br /> ��/,J /1'1 Gt{ZU �P � ����L'l�4w�tGc� Z•S�l /'`CJl+ty 4 � fq{/� �t�G��/ �� <br /> Ovmer MailAddress City Slale2ip Phone <br /> TEflant PAailAddress City Slale/Zip Phone <br /> �.Sc� �Lc u4-«. �ill 7.� �'`sg c��e.-u; w.f- ��sz� �,�s�,�:�s�y� <br /> ElecfricalConlractor P.4aiiAddress city State�Lp Pnone <br /> Os���� �a�. �3 z 0�( �� � <br /> Slale License Number(required) City of Everell Business License Number(required) <br /> I ����/���� _ `�a� <br /> �Propused Use of 6uild�ng CoMract Price of VdorM. � <br /> Square Foolage Qf residential new consiruclion, remodel or addilion) Contact Person/Conlacl NumbedEmail <br /> Number of devices(If low voltage) <br /> Description of VVork to �e Done !/UG� �'``I /a4 7`L lt-X`i�cct-S� r�`�.� <br /> --—T <br /> __ � <br /> FLF ----- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 G� Jl � <br /> ✓�/ <br /> I hereby certilylhaf I have read and examined Ihis appficafion and know fhe same to be true rnd <br /> conecL All provisions ollaws and ordinances govemm9lhis type ol work v�ill be tomplefed -- <br /> �rho(her specilied he�ein or no(. The gran(ing o/a permit does not presume to give aufhonty fo PERMITN� <br /> viola(e or ca�ce!fhe provisions o�any o(her slale orlocal law iegulating consfruc�ion orlhe r I� 0 � � ' �� <br /> per(ormance ol conslruc(ion. Thaf I am authonzed by(he owner ollhis property to pe�lorm(he C <br /> n�odc Ior which apolica(ion is made and I ccmpty�vifh !he S(afe Contrac�ors La�v i8.27 RCW and <br /> 296200 WAC. <br /> �-.�--�;����-�� /-�1- - �s � <br /> SignaWr Dale <br /> � <br /> I <br /> � . . . � ... . .. . I <br />