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ELEC�ICAL PERMIT AP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857— w'Cvi�-L��Gr�:�=,J.�-��Jt� <br />th.��� ('. Gd�:e.�Fi�PS � eVe•�'LT," :Jstr��9 ✓ . <br />-- g � 3� ��f'�� T <br />PP,OJECT ADDRESS <br />� F{Ih i'o Pi��C I �i'-17 <br />Ov:ner <br />� <br />..iu�1N�)��r �ti G`�Ir''1 j. <br />Tenanl <br />t.1ail Atldress <br />61a11 AdOress <br />���p�0%� <br />t d `-q `�5� <br />E � c�;,�-tT L. ;. j�'Z o I <br />City <br />City <br />Stale2ip <br />State2ip <br />Phone <br />Phone <br />(�V�liL:l:li= �LZ�TI� IC- {'b iiJ J( `�L�� �i 1°—�laaw`.i 4.iq, �� U� �' y � p.' <br />� 1 L'>'� � l2 � 20 �'L <br />EleclriCal CoMraC�Or 61ai1 Addres, C�y StatelZip Phone <br />i� <br />i- ���;�t 7 3et� v:� �2t i; ��i <br />State License NumbAr (required) Ci(y o1 Everett Business License Numhet (required) <br />� �U.°i <br />i�Piaf�l�.�� { <br />Proposetl Use of Building Contracl Price ol Work <br />Square Footage Qf residential new construclion, remodel or addi(ion) <br />� <br />Number of devices Qf Iaw vollage) <br />TS C-w�r�-n� rs�-n�n��.�.���ti�,���v.,c;,• <br />Contact Person/Contac( NumbeUEmail <br />Desciiplion of WorK to Be Done: __ ��•S�"�1L� (7�C�;;(,y 5•9V iN t i(,E1���1Li1M[.�' ��= ��C�� "S � <br />`�.A�i'LI 1-I1;� S� (N9:.i�'vl ft�'D)1 i rC_. C t ��• Ct f �'!'= <br />CITY OF EVERETT LOCAI. SALES TA� CODE IS 3105 <br />l hemby ceRily fhat I have read and examinetl this applicaflon and kno�v (he same to be lrue and <br />correct. Al/ provrsions ollaws and ordinances goveming this fype ol woik �vill be compfefed <br />whether specilied herein or noL The granting ol a peimif does nof piesume to give aulhon7y to <br />viola(e or cancel the provisions o! any other sfafe or loca! law iegulafing consUuchon or the <br />peAorrnance ol construcfion. That I am aufhorized 6y (he ou�ner o/ tfvs property to perform the <br />wo�k /or which applicaflon is made and I compty with the S�afe Contrac(ors Law 18.27 RCW and <br />296.200 WAC. <br />RE695EOOB/OiQDl9 <br />� L L %v L (�f <br />FEE <br />� 50. °° <br />/ <br />PERM?T# <br />E1510-frl� <br />