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ELECT�CAL PERMIT APf-�ICATION <br />uZ3 <br />� PROJECT ADDRESS <br />i <br />I � � F1 <br />� <br />I Ovrner <br />Tenant <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CGDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — w� ct�;�J _C �'r /�?` t✓� J r, ' <br />Clt�/..��. GJL'�L'i�i���5'��GVG��'[:r�"!d,'L•y'i1V <br />J �—Io--IC <br />, <br />f>+r.�� <br />� � ��� <br />Po 4:F I h-17 C�c1�<T� l v. (�-�' ( <br />i , <br />..Iu.t!-�)�'�E l,'J l:lr'i ; <br />�1 r <br />���pti��.:,_ ��Lt.-n=�c: <br />Idall A9dress <br />IdaJ i,ddre;s <br />, , <br />f't ;;a,c �{,.�� <br />Ciry <br />Ciry <br />��� 1='�u�,.,� <br />St�!c/Zip <br />5!atc�Z�.: <br />Phonc <br />Fhcnc <br />n , <br />l,.�n. `I �'i,'C C s ��fZ� ) `22 2c � � <br />� �!eCtncal Coniraclor bt;d Atldress C�ry Slate,Zip Phone <br />I ��'�! :.p•.;�t z:j�'� V"i L�ir � i 1 I <br />� Sta'e License tJumber (required) Cify cf Gvcrett Business License Number i;equired) <br />� ���I�i-J-I�L:i� ~ � D� i <br />Froposed Use of Buildiny Ceniract Frice of'Nor'r, <br />Square Footaae p( residential new construction, remcdel ur addi;ionj <br />Number of devices pf low voltaae) <br />��1 �1Mi�"Si1J Ist'I�14���4+^.'1Li N.Jlin1<��i1'.'11 <br />Contact Perso��Conlacl NumbedEmail � <br />Ucscription o( NJork to Be Donc CC.S�,=l�1L� ( i�i�( y 5.`�� � i� � i�_��'�..�c.cV�� t 7�1. C�- �;C„'��`c J <br />'�i !>'T'L� lal N=• � 141:J � l' ii: ��) � �? C�i &' t�a � f.�. <br />CIiY OF EVERETT LOCAL SALES TAX CODt IS J10; <br />I hereGy cerUly that / have �ead and rxmnu�ed fhis applicatron and kne�v !he same fo be true and <br />correct. Afl provisions ollarvs and wC/nances goveming thi; type ol �vork �vJl be compleled <br />�.vhether specdicd hcrein ornoL The yranfing ol a pennit does nvt pmsume to ,:ve suthont}� to <br />eiolate v� cancel fhe provisions o! any otherstate or/ocal �atv �egula(iny cons(raction or fhe <br />pcAormonce ol cons(�uction. Th,af I am authonzed by th,e owner o) thi; property te peilonn fhe <br />�:erk lor �vhich appl�cafionl, made ond I comply with (he Sfate Confractors La:v 18.27 RCLV and <br />296 200 4l�AC. <br />� i, <br />i Sign� <br />� FEl15E0C}q_'.+pN <br />'------ <br />_�� c�_ 7� _L (�`l; <br />CJ � � <br />F[E <br />�� �D.a? <br />PERPtiT:1 <br />El�Oa-a�f� <br />