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ELECTRICAL PERMIT APPLICATIOW <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —wwv:.everettwa.org <br /> L'-I I I ln��� � �vt��-f�-,WI� �$?l I <br /> PROJECT ADDRESS <br /> �.��cr.� Qaurwn� ZHlI I�nc S�- E�r,��- L✓/}��fjzol �IZS-LYB�d/ 7 <br /> Owner htail Address Cdy Slale/Lip Phone <br /> S� wi � <br /> Tenant Mail Address City StalelZip Phone <br /> IJW E1{cfi�c �„�l Se���- KD�I�($L3��J��� �,/ �+!lc c.✓l�/FS�sy yzs-�ir-os�+ � <br /> EleCtnCal Contreclor A1ad Address Gly 51ald2ip Phonc <br /> � DUo I�i"NE S SS76�- J517_3 I <br /> Slate License Number(required) Ciry�Everett Business License Number(required) <br /> ,���Si�rnce �,✓�So1ur �V SYs��+y � <br /> Proposed Use of Buildmg Conlract Price ol Work <br /> �h � �in$On��25"�06bS91��W�s��c��� v <br /> Square Footage(If residential new consiruction, remodei or addition) ContaU PersonlConiact NumberlEmail p M. ,�� <br /> v <br /> � (� rv�m a � � �r� vr�-f cr <br /> Number ol devices (I low vollage) <br /> Description ol Work lo Be Done: �✓t�� ��l,+iorl P� q rBOI 7DJ MBGr�7*P ��3z r�✓�C <br /> 5ojur I�V avs-{,r..-,. l6 K .�izk �Z7o-NE Z7o �.✓ _ r���� lr 4 - <br /> lX �-c,(< CShccc-�r,�� �V�' r3L�oo 3. ��k/ invc�f.c� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � D b� <br /> 1 hereby certily that 1 have read and examined this applicalion and know Ihe same fo be frue and <br /> correcf. All provisions ollaws and ordinances goveming this type ol work will De completed <br /> whether specificd herein or not. The g�anfing o/a pormit does not presume to give authonty to PERMIT# <br /> violato or cancel the provisions ol any olher state or local law regulating consWcfion or the � <br /> peAormance oI construcfion. That 1 am aufhorized by Ihe owner ollhis property fo per(orm fhe ��63 - a � 3 <br /> work Ior which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> °���7/ ���5 <br /> ' ignature Oate <br /> RELa5E00dO6'}Ou <br />