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' � • • � <br /> ELECTRICAL PERMIT /�►PPLICATION , <br /> ' CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVEREn, WA 98201 I <br /> ; 425-257-8810 - FAX 425-257-8857 -www.everettwa.org I <br /> I' G«, � �� <br /> I1.5 �d A � <br /> li PROJECT ADDRESS <br /> I <br /> ' ���<P v� 1-t�n'IP� �� �.I2,� ��(c.� a�:. 1-Ve Ce.�� u.Ll�} 3�o dSz l2 6S i <br /> � O',vner t��ailAddres� C�ty State/Z�p Phone I <br /> I <br /> Tenant MadAotlress Ciry State2�p Phone <br /> ' �� .J��c,� ��c�c;c. 561(� toy4�`j� Ne (�a��/5��1\e. �Jr� yz5"Z�I�ISS�I <br /> �, ElectricaiContradot MadAdCress C�ty Slate/Lp Phone <br /> Sw ��'cel 416PI�C <��7 S�� <br /> Slate L�cense Number(reqwred) Gty of Everett Du mess License Number(requrted) � <br /> � 9��� �C�,p II <br /> ')Io Y <br /> I Prop�se`�Use ol duddmg Contract Price of Work <br /> 2�� rj i-}' I �/I e C �-1 ZS J IZ SS.Z�_ <br /> � Square Footage Qf residenti I new construclion, remodel or addition) Co tact PersonlCon�ad Numbeq[maii <br /> Number o(devices (If low vollage) <br /> iDescnption of Work to Oe Done IlZ �J�t(��� '\0�).<r_ ��` /�e u Cj���� � <br /> --- -- FEE --- --- <br /> i� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 Q /1�jC� <br /> ��� 1 hereby certi/y Ihaf 1 have mad and erammed this applicafron ond kno�v!he same fo be fn�e and � v______ <br /> �' con�ecf. NI prowsions o/la�vs and ord�nances goveming this type o/�vork�vill he cornplefed ----- <br /> ' �vhe(herspecfied hemir iof. The gran6ng ol a pemuf does not pmsume fo grve aulhonty to PERMCf� ' <br /> � viofafe or cancel f��provis ns ol any ofher sfale or local law regulahng consfruc(ion orlhe <br /> , perlonnance oI constnicL n. That 1 am authonzed Gy Ihe o�vner ol this properly to perorm the E I S�S — U�"O <br /> �vork lor whicl�appli atio is made and I compl}�with fhe Sfate Confractors Law 18 27 RGW and <br /> I 296.20 � <br /> / S�6 2C�ls <br /> Si ature Date <br /> I <br /> i � <br /> � Fc���sroo��osa+aia � <br />