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—a25-757-1666 CMHEATING �00�..6a.m Oa-15-7015 3�- <br /> ELECTRI�AL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX A25•Z57-8857 —www.evereltwa.org <br /> 2?JZ3 rIQiIV �Y� �"NG <br /> PROJECT ADDRESS <br /> -('nn� �eas� 5o�n��asc�b�e- N25 355 S17Z. <br /> O'7+ner �dall Address Gty Slatetip Phono <br /> Tenanl Mell Address City SIa1rJZip Phone <br /> Cf►'1l�ea�inulr►c, 1�15 P�rCr�u�rua E�I��� WRq81�oI �z6 2�9 [�L��� <br /> [Iectrfcal Conlrattof �dalll4dmes Clt� ' StalelLp Phone <br /> CmF�M t+g77�� o i (�o4R <br /> Slala Licerse Num�er(required) Cily of Everotl B�siness Llcense Number(required) <br /> 2,�jp.00 <br /> Proposed Usu of Buildirg Conlracl Prico of Woik <br /> 1�7P.bbtR� �I Z'�Z59 Ldo(ol,o <br /> Square Faolape(If msldenlial new consW::Jon,remodel nr additlonl -Ca ct PersoNContaci NumbedEmail <br /> Numher of davicas (II iow volWpe) <br /> Descriptlon of Work lo Oe Done: I YISTLl,l�1 WC�t"�SS I�fl,�i ..�(9yL�,f7 S(.1,)�-+'Yl _ <br /> FE[ <br /> CIIY OF EVERETT LOCAL SALES 1'AX CODE IS 3105 j.�O O� <br /> I horn6y cerfiy flief I havo raad ond oxomined fhis eppiication an;l knoWlho sam9 fo Uo f�ua ond J <br /> cormcf. All prov(slons olfows ond ordinnnces goveming fhis typo ol wodt w(II be campiefod <br /> �vl�elherspecified horein ornol. Tl�o granfing ol a pom�i(docs not prosumo lo gfve aufhority to PERM17# <br /> viola(o or car.col fbo provisions of any ofhorstafo orlocal law repulallqg consfrucfion or fho � I �� � — Ory � <br /> peNormanco ol consfnic(ion. Thaf 1 em r�uthonznd by Ihe aWnero((hls pioporty to podorm tho "1 <br /> worklor which applicafion is mado and 1 comply with tho Sfate Confracfors Law 18.27 RCIN and <br /> 296200WlIC. � � � <br /> l,�.bbt� 1��0�C �lS I S <br /> C S:gnature/ Date <br /> l./ <br /> REVISCD 0495;GfI <br />