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i ---�--- � - <br /> �� ELECTF2ICAL PERMIT APP�ICATION <br /> � CITY QF EVERETT PERMIT SERVICES <br /> I 3200 CC-DAR STREET, EVERETT, WA 99201 <br /> i 47�-257-8810 - FAX 425-257-8857 -wvnv everettwa.org �/ <br /> � �� �.�-1��7 <br /> j �� E�, ��y�p -�.(Z <br /> I --31D � l��r �� F �c f� ur <br /> I PROJECTADDRESS <br /> I t,�;;d{�.��.Q;�� "31�5 I��Gif-iC hVE � YF.r",�rr �lT, 7$�0( Y?f•3v.t-18Jt <br /> �I Ov:ner A1aiIAdOre;s CAy Stale2ip P1one <br /> l� �. I <br /> I Tenant ttad atltlress Cny StateR�p Fnenc � <br /> II �n�t� F_t_.ecr�� �4oti M�ID��c�N�� A✓� F�,:a�:�- i,�n- q�7�� y�s-�sa-nvc� <br /> Eleclncal Contractor ldad Atldress C�ry Staie2ip Pnone <br /> �ANLLE1 �11L0� D � 7 � ��{ � <br /> Slate License Number(reqmred) City of Everett E3usiness License Number(reqwred) <br /> .�' ysD.c�a <br /> Proposed Use of Dudding Con'racl Pnce of Work <br /> 1'Mu ST�VE�1S 3LU 'L�I-OSII <br /> ds�e�ths2d�.l.l�lc<tr�c.ca:v. <br /> Square Footage(If residenUai new consiruction, remode;or adtlihon) Contad PersoNContact NumbedEmatl <br /> Number of devices pl low voltage) <br /> Descnplion of Work to Oe Done: C l�E'GU,� j FJrt' L-�D i- L✓�4 TE/Q ��r.q?E/,' <br /> LocA�r�n � N Mcu�N; N� <br /> _ . -- - _ FEe � <br /> � � �\ <br /> CITY OF EVERETT LOCAL SALES 1'AX COUE IS 3105 ��• (.'�J <br /> --iherebyceRJythall-have-read�antlexamioedfhisappl�caGon�and�knawthesame(otielrueantl-- -�— � - -- -� �� -�� - <br /> correcf. All prowsions o//aws and ordmances goveming fhis type ol a�ork�w1IGe complefed <br /> �vhefher SpecAied heran or noL Tfre gionhng ol a permd does nol presume fo give aufhonfy to PERMIT# <br /> violate or cancel Ihe prov�sions ol any ofher slale or local law regulafing consfrucGon or!he /� <br /> performance olcons�ruchon. That I am authonzed by the owner o!fh�s property to peAorm the E I �(v Z�Z <br /> worklor�vh�ch apphca'ion is made and I comply�vith the S(afe ConVactors Law 78.27 RCW and <br /> 246.200 AC. <br /> � w <br /> io - a� -� �� <br /> S�gnaWre Date � <br /> acvaFooaosan�e � _ _ _ � <br />