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ELEC�ICAL PERIIPIIT AP�LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FNX 425-257-8857 —�f tN t.�J -� �'��'�"`! z�.-t <br />��,.�x� 1'. edare-k-�zps �!� �v�r�z`-�' ����t�-�d J <br />� i � �.� N���.� <br />PROJECT ADDRESS <br />. t�14 i'D tij�jC I ������ <br />Owner tdail Address <br />Ctw�N�)d�E��' l7;'•r`�. <br />Tenant �qall Address <br />� �t-1:.c'Tr �� p� �/ �. Z�U � <br />Ci�y <br />Cily <br />Stale/Zip <br />SlalelZip <br />�D ✓ <br />� <br />9 - �-� S <br />E�svg-o�s <br />Phone <br />Phonc <br />f�U`:;�b;i.n�: �_I�Z'Tl' �L ('L 7;•a X i��f �� P-�Lvrar�) � °i � i <br />A. ���6�'S �`i�i")E�12 Zo�"L <br />Eleclrical Contractor Naii Atldress Cily Slate/Zip Phone <br />tr�; ���;�E 7 3��6 ��t �'� ��'i <br />Slate License Number (required) City of Everett Business Licen,e Number (required) <br />� OD <br />I�FI.�,.�ti.��� � � � <br />Proposed Use of Buitdina Contract Price ol Work <br />Square Foolage (I( residenlial neW cons(ruclion, remodel or addi(ion) <br />�� <br />Number o( devices pf low vollage) <br />la C"'UuSi2tlhl TSc'Yvw9.iv.2�i.NwtirV.,( <br />Contact Person/Conlact Number/Email <br />Descri tlon ol Work to F3e Donc: �-=•S�^��11L� (��C S•9V i N - ti� <br />P �,GY � iZ�`i'w�c..Y e'rv� 5� t�C,-�7 < <br />� _ <br />`�A'R+ (-/\N� � 149r.{i�l' 1�1�4i)S � f,• �J(�Gb�ll'-` ___ <br />CITY OF EVERE71' LOCAL SALE5 TAX CODE IS 1105 <br />I heieby certi(y Ihal / have read and r.xamined this application and know Ihe same !0 6e true and <br />correcL All p�ovisions ollaws and ordinances yoverniny this fype ol work �vill br. conrple�ed <br />wlrether speciGed herein or noL The granting ol o penni( does nof piesume fo give aufhority fo <br />vio/afe or cancel the provisions ol any other s(ate orlocal law regulafing con;froction or the <br />perlormance olconstrucfion. rhaf I am avthorired by the oN�ner o/ fhis property to perJorm the <br />work Ior ivhich applica(ion i� madc m�d I comply �vifh (hc Stale Con(rac(ors Law 1827 RCW and <br />296 200 WAC. <br />ItEV�5E009/OG20IS �3�'LL R� <br />FEF <br />� !� b D <br />PERM1Ttt <br />E15b°�—o�� <br />