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ELECT�CAL PERMIT AP�ICATION <br />�� <br />���� <br />PROJECT ADDRESS <br />t; �i �� <br />Owner <br />Tenant <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257 8810 - FAX 425-257-8857 — w/ �r w1-d ✓�+��.; ^' ���- <br />�' h,�ti� ('. ��t%re'�"-f.�Q5 � LV�'•rGY�' V,aJrL •�ld "✓ <br />�1 <br /><.� G..c. s � <br />� � ri`j� I h`j 7 <br />.Mail Address <br />C:fw1l���b�i��".i G'IIY ( <br />Mail Addre.s <br />E'� �i;,� rr <br />City <br />Cily <br />�,fJ ;i <br />g �10—t S <br />� isa �--d�S <br />j,.aN, j � ZJ I <br />Slale/Zip <br />Staie/Zip <br />Phone <br />Phone <br />1� � �/ p <br />I �.C��%Ltl.:�fZ �I,Z�11�IL ��6 IIJ�f i�6� V�-11°�-Vi\�.,i) �4. ��� �'�L•'i � � , <br />�IZ's ilZ'2�iZ <br />Electrical Contractor Mail Adtlress Cily Stale/Zip Phone <br />l�,!�.�p.-,�E x 3�'G� L�l <br />Stale License Number (required) <br />�'�v,,��nti�.;� <br />Proposed Use of Building <br />Square Foolage Q( residenlial new construction, remodel or addition) , <br />Number of devices (If low voltaye) <br />e2;��iy <br />City of Everett Business License Number (requireo� <br />ti 25(�, eo <br />Contract Price of Work <br />-TS C�-�u.:(Lt1�.1 r•Sc-rvwn�;�+r�i��w�wv.,c <br />Contact Person/Cornact NumbedEmail <br />Description of Work to Be Donc: ��SM��1L (�7�C'�{��y S'.qV i N �, �( �-j"ua�_�yv�E�7vj- ��� �.;(,;-17"e� � <br />`��•rN r1r�s � �4,:���" K=�i>� , Z-�•iRa��rr-s <br />CITY OF EVERETT LOCAL SALES TAX CODE I5 3105 <br />l hereby certrly Ihaf I have read and e.eamined (his applicafion and know the same to bc t�ue and <br />coiiecf. AI! provisions ollaws and o�dinances govemmg fhis type ol wark v�dl be completed <br />whe(her specilied hemin ornoL The granfing o� a permif does not presume (o give authority to <br />violafe or cancel the provlslons ol any other state or local law regu/afing cons(ruction or fhe <br />pedormance o(cons(�ucfion. That I am authorized by fhe owne�of thls property ro peAorm fhv <br />work Ior which applica(ion !s made and 1 comply wr(h (!te Stafe CvnVac(o�s Law i8.27 RCW and <br />296200 WAC. <br />•r <br />� <br />RCVISF008/74^VIJ '2l G� <br />V <br />FEE <br />�5� , �� <br />P[RMIT# � � <br />E j ��g- 0 � <br />