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ELECT�CAL PERMIT APP�CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425•257-8857 —www.everettwa.org � ,_a 4-�y <br /> GIUII -2�10 <br /> a511 E� bP-/IT1�� /tvE•�c�i�-tt" ��ao� <br /> PROJECT ADDRESS <br /> 4�-w�1 w W Y�-1 25► t ��L�+r.l b fi� �; wA� �i'�► �,r�w�t`��r�15� <br /> Owner Mail AdCress Ciry Slate2ip q�a� � P�one <br /> ��� � ��� <br /> Tenant Mail Address Ciry State2ip Phone <br /> -�wz i (awQ n �lQ.��� �531 3 i�P�� �C�� w�- q4.a�� �1-�-3�-�-a�.,a� <br /> Electncal CoMra r Mail Address City Slate2ip Phone <br /> A-�PI-t/kc�C�l t2a.MR G�`-1 c13rJ'—� <br /> Slate License Nwnber(required) City of Everetl Business License Number(required) <br /> l�1 D[��1,Il✓�tZ. � ��l"�D <br /> Proposed Use oi Building Contract Price of Work <br /> ►.��a�"�U,�1,�.1�2;�i�-3�L�-2 tD�`1 <br /> Square Footage(If residential new construction,remodel or addition) Contact PersonlContact Number/Email <br /> � <br /> Number ol devices(If low voltage) <br /> Oescription of Work to Be Done: �Y7L�"� l��-�T,1L ���C �i�1�il � h X'��'� �x' <br /> 1 � ��Ttt'�t�r.�. <br /> FEE <br /> CITY OF EVFRETT LOCAL SALES TAX CODE IS 9105 �oO� <br /> I hereby certily thal 1 have read and oxamined fhis applicafion and know Ihe samo(o bc tn�e anA <br /> correc(. All provisions ollaws and ortlinances goveming fl�is type ol work will be complefed <br /> wh�fher speGfied herein or noL The granting ol a permit does not presume fo give authonty fo PERMLT� <br /> violate or cancel fho provisions ol any other stafe or locol law regulafing consfruction or the � I�I � J � I � <br /> peAomiance o/consfn�ction. Thaf 1 am aufhonzed 6y fhe owner ol this pn�perty fo perlorm fhe <br /> work lor which applicafion is made and 1 comply wilh fhe Sfafe Contractors Law iB.27 RCW and <br /> 296.200 WAC. <br /> ✓ �� � �\-a�►-� iy <br /> S nature Data <br /> �rewseooa�ur.xi. <br />