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� � <br /> ,- - - — --- <br /> _ _ __—— - <br /> i <br /> � ELECTRICAL PERMIT APPLICATION <br /> ! CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 <br /> � 425-257-8810 - FAX 425-757-8857 - www everett�va org <br /> i � <br /> I �� 1 1 p� I <br /> ', � I U v �I:,(}1�:! �✓ F�•2�%�I v11•1� �D�� <br /> PROJECT ADDRESS <br /> � _1-_`s���� k��.��c- �Zs -3�3-z.j���i , <br /> I Owner I.tail Atltlress C�ty State/Z�p �'70��� <br /> � Tenant tdad Aadress C�ry SlaleiZ:p Phone <br /> i _� � �.c��cJ.�,-�� Z`�25 I I�'� P�- S � ��rT �,vA �,�1�► '1 z5-L7a-�f3� <br /> IElectntal ConVaclor '.ta�!A7:ress Gry Stalz2�.p Pnone <br /> �i o=s�u=3�9s�o�1 � 5 noof <br /> ' Slate I.icense Nu�nber Contract Pnce o`�\'er�K <br /> � <br /> I � <br /> IProposed Use of Building Contact Person (Plan Rev�e�•q <br /> I <br /> ' Square Footage Qf residential rew construc6on, remodel or addilioo) <br /> Number ot dev�ces(If Iow vallage) I <br /> —�i,.�ir_� Uru (��.k�3u;n.S -�-_L���� i;,�rF'Sl�`"--�-`� i <br /> �� Descnpl;on ol Work �u 8c Donc __ — — <br /> -���r{� K��+^� �)D 1.���tj� . ---__-- -_-__.____ � <br /> I <br /> � --- -- - I <br /> IfFF. - -- j <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� OO i I� <br /> I /hereGy ce�trty fhal I have read and eramineJ lhis applica6on and kno�v tlre sarne to he hue and _ � <br /> correct. All p�ovrsions of laws and ordinances yoveming this fype ol�eork�vdl Ge completed -- � <br /> �vhefher specihed herem or nof. rhe grantuig o/a pernut does nof presume fo give aufhority fo pERt•1ff» <br /> viola�e or cancel the provisions ol any other sfafe orlocal la�v�e9ulafing consfn�clion or the � I ,/ i1 "� �/ , lG <br /> nedonnance o!consfniction. That 1 am autho�i:ed b/fhe o:•,ner ol fhis properiy to peilunn the `� v41 "(� <br /> ivork/or�vhich applicati n is made and I comply u�(h fhc Sfatc Coniractois La.v 78 27 RCW ond 1 <br /> 296 200 WAG � <br /> i <br /> , �,;h Q.0 , as f�Zoi'� — <br /> L �Signatu r Date <br /> � nEv6ED1. 'tJ <br />