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ELEC�ICAL PERMI�f AP�LICATION <br />� � <br />PROJECT ADDRESS <br />+: �i K� <br />Ci`�"Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-3810 - FAX 425-257-8857 — w/ cv i.rJ -2 �'�,-�: �` a�rt . yp :% <br />�, <br />41t,�ti� l. e✓Lie�4-fc05 � G✓c�rUj'�' 'vlea,�Dil <br />g�a5-IS <br />Lf P� F�{; � r..) �-1 S� g�-� %� <br />1'U �ii� I'j`) 7 l; �C•`l'L�"1'j` 1.Ju� (� Z.G � <br />Uwner Ltall Address <br />CiZv1N�`VeL b•J b'��i'1 j. <br />Ton�nt A4aii Address <br />���1C�v,l�(; �I,Z?Il'�C- rU L'J;t 'j4�� <br />Eleclrical ConVaclor MaU qddress <br />;�l`.�p�;�t r 3�`� i.�, <br />Stale license Number (reqiiired) <br />iJ�l�i ���ll.�,v'j� <br />Proposed Use of �uilding <br />Ci�y <br />Clly <br />StalelZlp <br />Stale/Zlp <br />�� 1=(�li��,�,� L��.1, ��� i.'� L�'S <br />Cily Stale/Zip <br />Square Footage Q( residential new construction, remodel or addition) <br />� <br />Number of devices (if low voltage) <br />Phone <br />Phone <br />zs]�'"l2 Zo�L <br />Phonc <br />p?:� � I 'j <br />Cily of Everett Business License Number (required) <br />ti� <br />Contract Price of Work <br />�'�'� �"_V.!Ii2Slh1 rsc-hto9.iuf+2�. �vw�iNv-,t <br />Contact Person/Contac( NumbedEmail <br />Uescription of Work Io Be Done: ��� Sn'"�1L (��c�{,'y S�qV i rJ � �( ��'v: �Ltl^��(��t- �;� i�(,�I� c. � <br />���'TZi (-/�N5 � 1�ltiiil- _ Ftv��)S i �% (f': [.r.,lCS <br />CITY OF EVERET7 LOCAL SALES TAX CODE IS 3105 <br />I hereGy certi/y fhaf ! have read and examined this applica(!on and know fhe same fo bc fruc and <br />correcL All piovisions ol laws and ordinonces goveinint� fhis (ype ol woik will6e comple(ed <br />whelher specilied herein or noL The granting ol a permit does nof presurne (o give au(honty to <br />violate o�cancellhe provlsions ol any other sfa(o oi bcal lavi regulaliny consfiuctlon or the <br />peAo�mance of cons(ruclion. That 1 am au(horized by fhe oivner o( this property fo perlorm Ihe <br />�vork /o� �vhich epplica(ron is made and / comply wifh �hc S�afc Con(rac�ors Law 18.27 RCW and <br />296, 200 WAC. <br />HCWSE008iO4Q0�a _�j/—�-�.— /C.� � /,I_r_1 <br />1� _ 1 l __ <br />FE[ -- — <br />��V,�� <br />PERMTTtt <br />E 15b8 � I'11 <br />