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:1/20I2U1c 11: 15 206-244-2223 PEDEx OFFICE 5173 PAGE O1 <br /> � � �_l <br /> ELECTRICAL PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE7, EVERET7, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-�wvw.everettwa.org <br /> �� �a(j --1 y <br /> � � uir -i7/ <br /> 932a �nE,�v�,ti W�Ay, ErF�ecrr, �.,�A 9d'2� B <br /> PROJFCt ADDRESS <br /> f�7�rvcE ✓�4CE Lv v��R [ N✓rPcH 93Za n�snvv,.. wA x5 3 � - 66 <br /> Ownef Med Addresc City S10teZp Fhane <br /> il If 1 � cr � f <br /> TCnBnt Idall Addmss Ciry SlgtelZlp Phonc <br /> N'^' Eti%c-2�RiSF �c£cr�ic <br /> EIOCiNC8lCentfadOt MailA0tlrE59 Ciry SwtelLp Phone <br /> NwEN r�E SG 9 �!s O�� r �� 20 I , <br /> State Licensa Numher(requlred) CI of Everett Business Llmnse NumDer(requim0) <br /> Gr{vRer+ - Ho� sE oF w. �Ftsf/Q �'iS00, �—D <br /> ProDosed Use uf Bui�ding Con7act Price of Work <br /> Fy�., R-b�:�rantnf - 49 � � 35 7 <br /> � <br /> �/ol�iitse,l[.� nwew�Er�eliSeG'I��t„[ic. '�o"`'I <br /> Squara Foolaga pf 2sidential new consWction, ramodel or atldllfon) Contact Person/Contact Number/Emall <br /> � <br /> Numhof Of deviCCS(!(IOW VOItOgC) <br /> DescriptionofWorktoBeDonu: INSTA6L �z� EaE�fkfeql,.. (fo ✓4G Dv/�GE�CES /��'� <br /> SReE� 3 Pda?F- �TdQ . ��} Gnf�rl�6a� E�cai� i�A � ev�LS1c �PO,OoX ��� <br /> f1�a.n� c ✓k �PEN r �.oc �4,-� �N <br /> FEE - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � � „�7O <br /> I NemAy cortify fhot I Aovo reod and examinod fhis applicahbn and know the snme fu be frue and <br /> correct. N�provuions ollaws nnd ordinnnces goveminp flrls fypo ol work witl69 comple(ed <br /> whothor spoci�vd nem�n or not. Tno granMy ol a permil doas nof prosume fo,4lvp aulhonty to PERMITt! <br /> violnte or c�ncel the provisions ol any other sta/e orlocal la�v rpgulatln,0�onsbvcfion or fho � � � I r _ I� I <br /> perNmranco ol conshuchon. 7hat I am authonzed by fAe owner of lAls property!o perlorm the I <br /> work for whlch epplicat/on Is mede and!comply wd�tho Sfate Contractors Law f8.27 RCLN and . <br /> 296.200 WAC. <br /> o � ���Z �� � ° �¢ <br /> � i alure oaM <br /> ltENSED ORCYlOf a <br />