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0 <br />�LEC�ICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERV�CES <br />3200 CEDAR STREET, EVERFTT, WA 98201 <br />425-257-8810 - FF�X 425-257-8857 - w w i,�J -� ��'r-;�.�Y ��.✓ri • r:9 ✓" <br />� n„�; f'. ev�.e+tr ns �� ev�rGrf� !z��z .s � J `` <br />J � _a.5—�S <br />.� <br />E i S� Q.�I 7 U <br />L; ,1 � ? .r �,: �E,�,J <br />� <br />PROJECT ADDRESS <br />t �'�I� ' i'n hJl/� I h)`I � C. �C1LG�"j` L..v� G% � �o � <br />Ov;ne� <br />Gf2�'UN!)V�G w �t�pY` <br />'i'onanl <br />Muil Address <br />Nail Address <br />Clly <br />Cily <br />S�atellip <br />Stale/Zip <br />Phon_ <br />Phone <br />�N�;'J�:�:��� ��Z�n�ic: (�� i.JX ��ut. Iti�P-�va,.,, �'c.,r , , j <br />�' / .i L...)�. � L'�L�:� I'-iZ> /�'Zz'ZC!7i <br />ElBttrlcal Contractor btail Addmss Ci(y Slate/Zip Phonc <br />I�'�' �Du� t 7 �jC`tS l.�"1 D?:� i; l y <br />State License Number (required) Clty of Everetl Business Llcense N�mber (rcyuired) <br />� �'J f' I� i✓�Iti'I.tI�J <br />Proposed Use o( Building <br />Squere foofage Qf residentlal new constructlon, remodel or addition) <br />a�s�a� <br />Nurnber of devices pf low voltoge) <br />Descrlptlon of Work l0 Be pona: �`-'�SM`�1 <br />A <br />r <br />Contract Price of VJork <br />T�C�-1Mi2(�IJ l�Si..rito9.i�..;L� N„i�iNV.,t <br />Coniact PersoNConlacf IJumhedEmatl <br />Y S•iViN� 11C' <br />Li(.; 17'c; <br />`%��'71.� (-,'�,� 5� �Ul n� "t' F[:� J$ � 2 C[ tl. .c. � i� <br />_-° ------ <br />CITY OF EVEREi'i LOCAL SALES TAX CODE IS 3105 <br />I he�eby ce�tify fhat ! bave read and examinvd Ihis applicallon and know fhe ;ame to be (rue and <br />conbcf. All p�avisions ollaws and ordinances goveming firis fype u/ w,odc will be completed <br />rrhelher;peci6cd i�erein or noL Tne grantrn9 of a penn7l docs no( presume lo give authoir(y to <br />violale or eance/ fhe provisions o! any ofher sfate o� local law re9ulating constnicfion or!he <br />peKormance ol conslrucfion, Thaf I am auUto�ized by the otvrer o/ fhis property (o perform the <br />ivorklor evhich applicafion is made end ! comply wi(h fhe Sta(e Contractors La�v 19.27 RCW acd <br />296.200 WAC. <br />NLVISE009/OGl.'014 ��.C� —n` /_(�� <br />I V � __ <br />FEE � <br />�50. °° � <br />� <br />��rR�— Mrra ------=; <br />E15�-��v -� <br />