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ELECTRlCAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, [VERETT, VVA 98201 <br />425-257-8810 - FAX 425-257-8857 — w/ w vJ-C �'er�� ��s.'- .vkD '� <br />�ei. ;l� coer�k�e s@mv�r�-F:e�eL.���f <br />' �" � o J <br />���-lS <br />c, � iv o-7 �2� <br />�.5�7 �Lu�,; <br />PROJECT ADDRESS <br />O�vner <br />Tenant <br />��{ `W Pp h.Y � h �,� <br />Nail Addre;, <br />Cf2;:� N�?'�' i�iti �;� r"Y <br />t✓lail Addres, <br />E vi�r c�T <br />Ciry <br />Clly <br />L..\ `(�Z°I <br />Sla�e/Zip <br />SlafclZip <br />Phone <br />Phone <br />I� uIC�LL li\� �I.G�Zi�i121 C. f�G �;�u X i� �' �l l°�iMl��� L..i4. �� J � E� S � <br />I I ZS )�'ZZ' ZU � Z <br />Elecirical Conlrac�or Mall ACtlress Cily SlalelZip Phone <br />�111�.��u�E z 3e� ��, <br />State Ucense Number (required) <br />I�Praf��a�,�t5 <br />Proposed Use vf Builtling <br />Square Footage Qf residenliai new construcfion, remodel or addition) <br />Number of devices (II law vol�age� <br />�7�i;�y <br />C�ly o( Everett Business License Number (required) <br />„$ �'rJ �. �D <br />Contract Prlce of Work <br />TS �SV.�S.flLilnl TSc'hw9�ti�s+26t�v�,.i�i,.�lt,i <br />Contacl PersonlGontact MumberlEmail <br />Descdpllm�ofWorkto�eDone: CCS�Kc11L (�7"LTy'�`� SAViNI /(,i-�^u��El^�f'J�'t- G� �-1i,NT'.� � <br />`�l��nl Fn r� S 1 f4� nl Gl " li�� t) 5 Z c:� r:,., � iS <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I bereby certity Ihaf I have reaU and examined this applicalion and know tbe same (o be frue and <br />rorrecL FII provisions ollav�s and ordinances goveining this type ol ivork r�il! Ge complefed <br />�vhefhe.r specilied hcreirr ornoL The qrmafiny o7a pcimi! does naf pmsumc to give authorify lo <br />violule or cunce! (�e p�ovislons o( any ofher sWfo or local la �v regulafiny cons(iuclion or 16e <br />pr.Aormance ol conslruction. That I arn aufhorized by fhe owneru/ lh/s property fo peiform fhe <br />work for ivhlch npplica!!on is made and I comply ivi(h fhe S�ale Con(ractors Laiv 18.27 RCW and <br />29G.200 WAC. <br />R[V�^.COOON�R019 ���LL <br />FEE <br />�SU,�o <br />P[RMITit <br />E I�p�l J 22) <br />