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ELEC1'�ICAL �ERMIT AP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, lNA 98201 <br />425-257-881 U- FAX 425-257-8857 — i.�,� ti�; �'.�' i�L.�rl �,,� �. �..i <br />Ci�,;��1 �vctre-l�le�,g �,E iy, f w:i `��. <br />� lc GF :�V <br />J <br />Boy P„�L <br />PROJECT ADDRESS <br />t Ftti1 ��o i,e� � . � h <br />Uv,ner � � � � ��1;,.:T <br />Pdail Addreas C�;y <br />Glii.�ia��y���lA.� �:�r'r <br />7�f13�! <br />4� <br />i����C�v �:��: �L�Z�1=iL <br />Elec!rical Contracloi <br />�/��'��-���l�t 7 , 1 r' <br />�l� l.� <br />State Lic�nse fdumber (requiretl) <br />I,I V i� i�ii.e�" I� <br />Proposed Use o( Building <br />:���I n(1�� 255 <br />f�a r;�a X y�'°/ <br />A1ail Address <br />LIIY <br />l�� i'_t���,.,� <br />Ciiy <br />Square Footage pl residential new construction, remotlel or add�tionl <br />P;umber of devices pf low voltaye) <br />Descnption of Work lo Be Done; �l' �n'•�1L (. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />1,–�S. �/ �' �L' J � <br />S:d:C/Zip <br />Sta'e4JF <br />1,.J� , �j � �� -' ' <br />—�° Y <br />Slate/Zip <br />PI:OtI? <br />�_ I <br />FhD'1C <br />Z� ):�^ i2 2.� i"L I <br />Phone <br />��l;ly <br />Cily of [vereC �usiness License Number (required) � <br />� �,�� � <br />Contract Price ot VJorY. I <br />t <br />TS c�,�n� rs� -��nwW.r• � ., �. �.,c.�"+ <br />Contact PerseNCcn!act Numbcr![mail — <br />I <br />V SAV�N�; � <br />Gi✓rc<��r- <br />� hereby certily fha7 I have read and e.camined fhis apphcation and kno�:� the same (o be lrue and <br />correct. A!I piovisions o(la�vs and ordrnances goveming thls (ype o/ ivo�k iril/ be complefed <br />�vhether soeCrOed hemrn or not. The granfing o( a permif do:s not pmsume !o giva authOn(y (p <br />v;olate orcancel the prpvision; of ar.y other state orlucalla�v regu/a(ing conslruction c� �he <br />pe�lormance ol consfrucfion. Thaf I am aulhorizeU by the o�mer ol fhis prooerty to perlorm !he <br />u•ork !or �vhrch appl,cation is made and 1 comFl% �ti•�th fhe Slate Contracfors L nv 18.27 RCW ond <br />296.2C0 NJAC <br />1 <br />�: P!5[J C995:o r� <br />� <br />L L_ 7u E (�f /�---- <br />� � G;-� i 'c <br />FEE —�—' <br />D �� <br />� � � <br />PERh1ITx <br />E����%� <br />