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ELE��fRICAL PERMlT APPLIC�TIONI <br />CITY OF EVERETT PERMIT SERV�CES <br />3200 CEDAR STREET, EVERETT, WA 9820 i <br />425-257-8810 - FAX 425-257-8857 — www.eveiettwa.org <br />,� �� �/'t/ ��`^'� �lC� �i <br />PROJECT ADDRESS , / <br />Owner <br />Mail <br />�j <br />Tenant Mad Address <br />�1-�,.–f c=s �"/� �, 7-3/ <br />Eledrical Conirector PAa�.I Add«:s, <br />�r �ZD J `J/�'- / <br />Slale License Number (required) <br />, � �e5� <br />Use of ui�diny / <br />�3000 <br />Square Footage p( residentlal neei <br />Gty <br />Gry <br />02� ��. �.G� <br />— �Y <br />or <br />SlatelZip <br />StalelZ�p <br />� 1Y�IG/�t' <br />State/Zip <br />Nnone <br />Phone <br />�`,�1�zyZ <br />Phone <br />V�✓ �� <br />ity ol Everelt Business Ljt.C;nse Numbcr (required) <br />C!!'J <br />�� , - <br />Conlracl Price of Work <br />Conlact PersonlConlacl NumbedEmail <br />Nwnber of devices (If low voltage) <br />��/�J r <br />Descrip�ion of Work to �e Oone' -�',-{�. ` C�----_ -_— `- <br />� <br />F[E -- <br />CITY OF EVERETT LOCAL SALES TAX CODL- IS 3105 �/J / �� <br />�l/ <br />I herehy certi(y thal 1 liave read and exarnmed lhis applicntion and kno�v (he samr. (a be hue and —. .. <br />correcf. All provisions ollaws and orrlinanr.es goveming Ihis fype o� work will Ue cornple(ed — <br />�vhethcrspecdicr{l�r.rein ornol. The qianling ol �� pennd docs nol presurne fo y�ve autl�aitylo PERMITii <br />vioLNcy ��mcel ll� provisions ol any ofher statc or lor,al law regulating r.ons(n¢lion or fhe I <br />pr.dof/riance olr.on c(ruction. Thal l am aufhori d he o�vnerolffris p�operty to per/orm Ihe E I�-�' I 2� !3 � <br />worJc Ior wnir.h app�cafion is made,��nd con � y y���e State Contrar,tors Law 18 27 RCW and _. <br />29b 200 WAC. /% /�� � <br />.�C/—!—[�� <br />Datc <br />nr-viseo oeiaeaow _ _ <br />