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�— —_ _— ------�---------- <br /> � --------------� <br /> � � <br /> ELECTRICAL PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www everetlwa org <br /> I <br /> � <br /> I; ? 7 I � �-4 L��. l T T_�L�= <br /> iPROJECT ADDRESS <br /> �� �-'—�- l�0 C5 0 ,� <br /> M�v.c�rt /.��� Q�PAs� �_� l:��� � _ �i'�-�,Azo6l�l l� zg �t$o <br /> Owner h�ai�daress C�iy sia�c.�z�p ' Phonc <br /> 4•�v.� f1�:0��'l�t� 2zio ��Ewrt dv� <br /> I �j�.( �.4�v.'!��iE C , �/I T.. 3�20 �-�!:J'��L'S \�i GJl�iGO( _ <br /> I 7enant 1�iad ACdress C��ly SlateZp Phone <br /> t�2c — U ��� : � 3.��5 S�+ o�2� sr �4�,2�u V.�!{ �'wi '1z5 z5 z- g97 <br /> Electncai Contractor �,1ad Admess Gty State�Z�p Pnone i <br /> i <br /> N�� Cs I �� E L c� o �r�T �_.:.��--����t��v_.� � <br /> State L�cense Number Contrect Pnce of Vtbrk � <br /> s 1 0 k7.�i [� �i <br /> Proposed Use of Gwldmg Contact Person (Plan Rev��.ew; � <br /> I <br /> �' <br /> Square Footage (If resldenU�l nev+construction, remodel or adddior.) <br /> � Number of devices (II low voltape) <br /> I <br /> Description ol Work to He Done� l� i\ l\ 1 LIZ � J I S l%OJ' ���4 LT �,12 �/t�-✓ ��'A-�_ 4 L(j�ut- , � <br /> I <br /> Loi�ly�C�1LAL�.i_t.+y Y�ld�'-- ---- _� <br /> -- — — --------- <br /> FEE ------ - � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 8 ".S � <br /> I hereby ceRdy tha(1 have read and exarnined(his applicafion and Nnow 1hc samc to be fn�e and _ _ _ <br /> curmct. All provisions o/laws and oniinances govemmg fhls fype o!u�ork n-ill be comple7ed — <br /> a•hefher specdied hemm or no( 1 he gronfin9 0l a pennif does not presume(o give aufhonty fo PERh1fT:. <br /> violafe orcancel(fre prov�sions ol any olher sta(e or7ocal la�v mgulnfrng consfn�cfion or the <br /> perfomiance ol consfrutfwn. That I am authonzed Gy the o�vnero/fhis p�operty lo perfonn fhe E I��� � yS <br /> �� worf�'Icr�vhich apphca6on is nrade and 1 comply with the Stafe Confractars Lan� 18.27 RCW and <br /> I 296.200 V✓AC. <br /> -�4,G�r0 G1/L�� s/ 2� L���,; <br /> S�gnature �ate <br /> tiFV�5E0 1:C'U <br />