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IJ/16/201, raz te: aa rax �ooi/ooi <br /> � � � QG��_��"��Q� ��1G�� � Y1LQ I�.C-�c �� �6V�1_ <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, [VER[TT, WA 98201 <br /> 4i5-257-6810 - fAX 4?5-?.5?-8857—vrvnv.everelhva.gov <br /> C������J � <br /> Ib -t�j �iS <br /> �k17L-���1�P� <br /> PROJECT ADDRESS <br /> ��,�;n �,�c�S Uo2.��r��1 �l�Yet� , �l� �1��0� �tZ�� �11'i� ���4 <br /> OwnEf h10ilAC3rCs5 Gty StatclZip PhcnO <br /> Tenant l.lailAUtlress C�ry StatefLip P�onc <br /> 1 <br /> � 1��L�C 1�6\l S.2" �. �1�o��n1- lovni�l �1i�� O1�1�� �- �°i . � <br /> � � E 6�� I�-1� L/Ci� c�! � �/—/ ��Ii�— '�,{(/1�tV�'!� �lJf! �� `"L V !�� P��nc <br /> �� �l <br /> Slate License Number(requ:red) � � Cily al EvereU Business License Number(requi:etl) <br /> ����� �� � � ���� <br /> Proposcd sc ot 6uitding ContraU Prcc o1VJo:k <br /> �1��,V,l,�..�l�l�l�l- ���•�I l�'���gD <br /> Square FooLige(If residenlial newconstruction, remodel or adCdion) Conlact Person,l/Co'nta�Number/Emai <br /> ���1�-(��1'll� ' � �' C' �QCI <br /> Number of devices(Il low vollagc) <br /> DcsuipGon of Work l0 6e Donc� �� (� V�` W`�`� \V\ �Q,V�J �1�,��/�,�Q . <br /> ��- _-- <br /> CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 �O Q��� <br /> • <br /> 1 heroby ceRily fh,if I havo road and o��ammod fhis appficaf�on and hno�v tho same to bo Wu and <br /> corroct. Aq prowsrons ol la.vs and admanrns govoming p�is fypn ol Nnd;will bc comp!ated <br /> a�hofh�rsporificd hcrem or not Tbr. granfing ol a pwmif does nol pmsumc fo give eulhonty fo P[RMITN <br /> viofe .��canceltheprowsionsolanyofharsfafeoNecallaw�ogula0ngmnslruUwnorUm � I /�O_�,/�� <br /> per ormanco o/cansln�clron. That 1 am aulhonzod 6y fho own�r o/fAis pioporty fo pedo�m Iho S �� <br /> �v /or•,5'iich ap ' otion is made an cnnrply wiU�fhe Sfafo Con'vacfors Law 18.27 RCIY ond <br /> 2 �200 4YAC. i <br /> / / <br /> tiignalure fYdte <br /> an�iSFO�e)5:c'� <br /> L_____ __ _____ __ ___ <br />