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r� <br />u <br />� <br />ELECTRIGAL PEiRMiT APPLICATION <br />� CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 96201 <br />! 425-257-8810 - FAX 425-257-8857 — wvrvo.everettwa.org <br />6��-,� <br />� a�o5 I�o�t � �ou.,�� Eiso6-v��( <br />I P�OJECT ADDRESS <br />aY.: � <br />� Owner <br />Ma�lACdress <br />li Tenanl �7atl Address <br />i� � V L�YI1r6 a I�D �bk � 32� <br />I lectncai Contractor I ail AtldresS <br />' Dur�STt3►q�i4 J <br />. <br />State L�cense Number Irequire�) <br />1r-�S 1 G� -2U��(.�L� <br />'�, Proposed Use a( 6udding <br />Square Footage pf res�dential new construction, remodel or atldihonJ <br />Number ol devices (If low voltage) <br />�escnpl�on of Work to 6e Done <br />City <br />�„� <br />Stale�Z�p <br />State2�p �� <br />Stale2ip <br />�w� <br />PMne <br />03q I�I 2 <br />City of Evereti 5usiness License Number frequired) <br />25� � <br />i,ontract Pnce of Work <br />aoc���BBgz� <br />Contact Person/Contact NumbedE-mail <br />brad�l�cr� msn�co <br />� � "1 � I / � "�-� `-'� <br />FEE — —� <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 7105 �� � <br />1 hereby certdy Ihat 1 have read and ekammed Ibis app��calion and know fhe same fo be Irue and ____ _ <br />conecf. All prov�sions o! la�vs and ordmances govemmq Ihis type o! n�ork �vdl Le comp7eled — - <br />whe(her speci�ed here�n o� nof Thc granfing o/a permAdoes not presumo lo grve aufhonty fo PERMIT# <br />violate o� cancel Ihe n�ovisions ol any ofher slafe or local law regulaling conslruc6on o• fhe !� � I��� — O I <br />pe�for�nance of ro� ,truchon That I am authorued Gy the owner o/ this p�operty fo peAorm fhe <br />�sork 7o�)v(riclr applrcatioD is matle and I compty �vdh fhe Sfafe Confractors Law 78 27 RCbV ,�nd _ <br />?96. 200 WAC % / <br />^ <br />�rc6F00B26C0u <br />