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Ap �. 22. 2015 10 03AN� IJo. 9011 f'. 3 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 'L 15 �4 �l�-lO <br /> �iSi�l �1 c.-rnv� � 4 _ �3—15" <br /> PROJECT ADDRESS <br /> �•alle Teaq�.v� �0�1 N��-rnvi � F�lfs-s-f- �t..4A- 9sna� u,� �,�i �st�, <br /> Owner MailAddmss Cdy State?.Ip ahone <br /> T9nanf Mml ACCress Giry Stateltp Phone <br /> D�J �`�►�1V� �i�{�q �iVPXQ-t{' 'kNE ,1! /A'Pt c. 1FF- �'tR7F1 � �Z�'Z�'Z `'f�(Ua. <br /> Eledncal Contractor !deilAOdress Ciy State/Zip pheno <br /> (�«eTt;S�q��2.rC F� I�l f��r� <br /> State icense Number(requiretl) Ciry of Everett Business License Number(reqwred) <br /> �S;dwn���.Q � 9S� <br /> Proposed Use of P,uitding Contract Prite of Work <br /> C ' <br /> Square Footage Q(residential new const�uction,romotlul or edditlon) Contnet PersonlContad Numbe mail <br /> Number of aevices(If low voitage) <br /> DescnpUon ot Work to Be Done�. �S I//..f i ��iYP $. �I S�ll�Y1V�0<'�" C✓�S�f (11��{. �- <br /> �N ����,�� <br /> FE[ <br /> CITY OF [VERETT�OCAL SAL[S TAX CODE IS 3706 � �T �p <br /> U � <br /> f hero6y certify fn�t I h3ve road and eraminod Ihis applicalion antl know(he same to be fru�and <br /> carec[ All provlsions o!laws end ordinences govemrnq fhis rype o/work w.dl be com0feted <br /> wh�thor spoc��ied horrrin or noL The gran6ng of a pormrt does not presumo to grve authonry to � PERMCft! <br /> violsle 0�cencel thA provision5 of ony aMCr stafe o�lotal law regulofing canstruction or thc <br /> poAorrqanco olconsUuclion. fia(1 am authodzod by thu owner ol this pioperty fo peAorm the E l��� I �D <br /> v,�ork!a which application is mede and I comply wiM the State Cantracrors Law f y.v RGw and <br /> 296.200 WAC. <br /> `7 <br /> /�/�� <br /> Signawre ete <br /> flEVI5p089540H <br />