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ELEC�ICAL PERMIT AP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STREET, EVERETT, WA 9E3201 <br />425-257-8810 - FAX 425-257-8857 — u,� iv�v -��'u`=": :✓�t J�� r <br />C h.,� �( G✓c! ��-f -i � P S�� tic-rGf'f t�J:!_ � d 1 <br />� � � � � �r�.� ST �, �,� -u�y <br />PROJECT ADDRESS %Q �9 ��5� <br />0�•:ner <br />Tenant <br />t fi F1 Po �=i�F �'�`I <br />Atail Atldress <br />Giklr'�)dit vJ G'�� i <br />I.Sail Aaaress <br />[�l•IL�T� �J�, `� � LD j <br />City <br />Clty <br />State/Zip <br />Statc2ip <br />F�honc <br />?honc <br />�' p <br />I I ��Cl)L: ll('_ ��5�•�� �L 1'G 7lJ �{ l���� ��i 1°�LlnJni� �ip. �� �' �. i,` S � 6' '. <br />I�IZ)��Z: Z��i� <br />EI?ctnCal ConhaCtor f'ait ACdress Giy Stale2ip p��ppn <br />I��.' ;.p,;,.E z 3��i� ��� o� c:� y <br />I Stata Ucense Number (required) City of Everett Business License Number (reqwred) <br />� f�Fl1^�1?'�r��'I � '� �/JU .� <br />I Proposed Use of Bwlding Conlract Pric=of VJork <br />� <br />Square Fcotage (II resldential nev� construction, remodel or addition) <br />�r <br />P:umber of devices (II low voltage) <br />Description of Work to Be Done: � <br />���'LUSf..S1�J i St-YNoT:w:.� iv�,.:ti,.�v.�� <br />Contact PersrniContact NumbedEmail <br />i�l"ij�,t'y SA'viNl; f�c-1^���(..1�(7�i- :7= Li(�rl'I"c <br />`l�.fi'fL1 F/�N> � Ii11J.>l" h:bi)� C� ( !; <br />CITY OF EVERET7 L6CAl SALES TAX CODE IS 9105 <br />� 1 hcieLy ceRdy fhat I havc read and exarnined 7hu aFplication and kno�v fhe same !0 6c true an� <br />� correct Al! provisions ollaws and ordmances noveming this type o/work �t•ill be completed <br />I;���ether speci�ed hemin or not. The grantiny ol a peimir does ncf pmsume to give author,ty (o <br />Iv;olate o,-cance! fhe p�ovisions o/an� other sfafe orloCal law regulatinq consfruction o� (he <br />FeAormance ol construcfion. Thaf I am aulYorized Cy7he owner ol this property to perform the <br />i.ork (or �vhich applica(ron i; made and / comply;�ith fhe State Conti�ctois Law PH.27 RCWar,d <br />� 296.200 67AC. <br />I �� <br />I S�gnoi <br />i <br />� rEt,�5E0:±C:%::ta <br />��—LL__ �Z� C�( <br />FEF <br />��,� <br />PERh11Tk <br />E��J��'��� � <br />