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-� � <br />ELEC1'RICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - i.;/ t�iuJ.2 ve+r��-`.�/ =. :e�) ,/ <br />e ii.,a� 1•. �✓¢�e-I -F.e p5 � eV�rGi� 2e�u_ .��J •� <br />� <br />� � �> <br />PROJECT ADDRESS <br />� �� 1�1 <br />l� � I�+ �ic N <br />po i�� j, ��j�� 7 <br />OwnM 4dail Addres; <br />GiiN�Nl)U�E-vJ ���rY`5. <br />Tenanl <br />�dail Addre,s <br />E vl�YLr'T'(" <br />Ci�y <br />Clly <br />� _ a. 0 `- I J`� <br />C- � so���� y <br />�-;,. �l � 7 D � <br />StatelZlp <br />State/Zip <br />Phone <br />Phone <br />/ <br />� '��V L:1f- �Lc"t�-121L (�6 fia jc `�U�� l�l P�-t��s'a,�) L...)q, `I''V C�� 5 (y Z) j S lZ � Zo � C- <br />FlectricalContraclor MailAdaress Cily Slale/Cip Phone <br />�r�'•.��w�t z 30� v, �z,: �i �l <br />Slate License Number (required) City of Everelt Ousiness Licence Number (required) <br />��v��r�,ti,.� � 25 C� <br />Proposed Use of Duildiny Conliact Prlce of Work <br />Square Foo�age (II residential new cons(ruction, remodel or addlllon) <br />aw_� <br />h:um6er of devices Qf Icw volt�ge) <br />Description o( Work lo Be Done: ���•S��^��11 <br />� S C'1.uL2ili.1 "rsc'1}w�Ktv�r},N�. �v..i�iHk�i <br />Conlact Person/Conlacl Number/Email <br />� SAVIN� r� <br />� �G,-n-t <br />���� r�Ns � rua,��c r�.��>S � � � — <br />I i..c,w � TS <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />If heraby ccrti7y fh�f 1 have read and examined Ihi� applica(ion und know 1he sarne (o be frue and <br />canecL AI! provisions oll�:vs ond oRJlnances govemri�g Ih/s lype o/�rork wil/ Ge cornple(ed <br />i:vhe(her specilled he�eln ornoL The grnnfiny ol a pcmrl( dces nof presume fa 9ive au(honty 10 <br />i violofe orcancel (he provlslons o! any nlhe� s(ate orleca!!ov regulafiny wnsliuction or the <br />Iper7ormance ol construclion. Thaf I r�in au(hwiled by (he orvnerol this ploporty to perlorm the <br />�.:�urk Ior whlch applica(lon /s made anAl compty wilh (hc Slotc Confruc(ors Lmv 1H.27 RCWand <br />� :'9G 200 WAC. <br />J / i <br />� �:�� �� o�� <br />Signalur���� w ---p;,le I 7 — <br />r.rv,.smoa.accc�< I�LL 7D <br />- — ---- -- --�----- -. C�(�f�;— <br />fEE <br />�� <br />PERhifl tt <br />E I 507 - I � �- <br />