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�-�� M <br /> I _ _ - - - - - - --- - - --�---- <br /> ! ELECTR�CAL PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX Q25-257-8857 —wwtiv.everettvaa.org <br /> I <br /> � p���a z-�3 <br /> 5���- '��..�k��e,..� LN a `ao —i5 <br /> PROJECT ADDRESS � <br /> G,�L I.en H klevi 5��� P��lt�u�l.N Lt�l�n,� W S� ��6�a� �Z5 613 18�3 <br /> Owne� tAailAddress Cil;+ StatelZ�p Phone <br /> � <br /> Il�en���: M1lailACdress Ciry StatelTp Phc�e <br /> I �f ��,�� Zn� �{`�3\ �J 3vuW A�vo G-i g'�� �oy—��_����� <br /> E!edriealCor ractor 1.iaililddress City Sta;eiDp °hene <br /> � <br /> ! ���J�l�'�z5`t�C�� 6.��.� 16 <br /> � <br /> I State License Number(required) City o(Everett Business License Number(required) � <br /> I <br /> IProposed Use of Bui'd�ng Conlract Price of 4\'ark i <br /> I <br /> Square Foolage(If resident�al new construction, remodei or addition) Conlacl PersonlContact NumhedEmad <br /> I Number cf devices(If lovi vollage) <br /> I Description ol Work to Be Done. LD'� � _����--�-r��n�� _ I <br /> � — <br /> FEE- - ---- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS �105 � v� "% <br /> r/ <br /> 1 hemby certily fhat I have maA an�'examined(his applica�ion anAkno�vlhe same 7o he(rue and ___ __ <br /> conecl. All provisions o/laws mid rdinances govemin9 this fype oI u�ork will be completed — -- <br /> �vhe(herspecificd herein ornaL 7"1 c�n.nLng o/a pennif does not pmsurne fo give authonty to PERh11Tr` <br /> violate or cance!fhe provisions ot� ny olher sfate or local Imv mgula7ing consWc(ion orlhe <br /> per(onnance a/constnrcfion. Tha! 'am autho�ized by the o�vner of fhis pmperty to perforrn fhe E ���0 Z -Q � � , <br /> r:ork(or�:�hich applica(ion is mad, and I ipty n•ifh fhe Sfate Confractors Law 18 27 RC4V and <br /> 296.200 VI�AC. /' <br /> / 7�( Zd ��l <br /> -� Date <br /> �F���cr�nca�aa.ra <br /> ----- ---- - ------ -- --- <br />