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L <br />� <br />EL�CTRICAL PERMIT APPLICATI(�N <br />1 � � WGuS'i <br />PROJECT ADDRESS <br />� F� V�1 <br />Gerner <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857-www.everettwa.org <br />rD �_� i �;�� � <br />Mail Address <br />C�i�v1NO�l��L' Udr f 5. <br />Tenant Mail Address <br />E�'-�r^='�T <br />City <br />City <br />6�I�—��S <br />� IS46-o�(0 <br />L�i;a j yJ LO � <br />si�a�rz�P <br />StatelZip <br />Pha;:c <br />Phane <br />Ih/�Du�:�('- �I,cZi'YLiC. �6 ���F `i$�� Ir��i'-l��.ra��� LJu. °IiJDE3 �yZ>)6ZZ-Zu�"L <br />ElectriCal ConlractOr Mail Address City Stale2ip Phone <br />1�'�''-cpH�e s. 3C`� <br />State License Number (required) <br />;��f�i�il'l��'�1% <br />Proposed Use of Building <br />Square Foolage pf residenlial new construction, remcdei or addition) <br />�—� <br />Number of devices (If low voltage) <br />t�v- c: i y <br />City of Everett Business License Number (required) <br />h <br />Contract Price of WorM. <br />I, G�rSTII.��y TSr.-�iU�H1.Y1.i.�1�1�LIN(C�( <br />Con�act PersonlContact NumbedEmail <br />Descrip�ion of Work to 6c Donc: �Sn"�1L� �7���i SA� i N � Q,e'{'u�c.�l"'�� G� ���rITS � <br />93n•n.L G�,�s� 2r�.,��� K:>vi�5 3�nn�ti i�n <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! hereGy certily that / have read and examinetl (his application and knorv the same to be lrue and <br />correct AI! provisions o(/aros and ordinances govemin9 lhis fype o)rvork n�ill be completed <br />�vhether speci�ed herein or noL The granling o/ a permit does not presume lo give authority to <br />vio/ate or cancel fhe provisions o(any ofher state orlocal la�v regulatin9 construcfion or the <br />perlormance of construclion. Thaf 1 am au(horized by the owner o/this property to pedorm the <br />work for �vhich applicatron is made and I compty �vi�h the Sfate Conf�actors La:v 18.27 RCW and <br />296200 WAC. <br />DGI��I�S <br />Rev;sEooe�acrzow r���CL 77� l�%�� <br />FE[ <br />� � �� <br />PERMIT;f <br />E c�o�-d�,� <br />