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----� <br /> LECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PEP,MIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8890 - FAX 425-257-88SI —�vww,everethva.org <br /> � / 2--1� "<<f <br /> J��'�� - ,� �, , �� ^ ;r � ,^ ._�,_ _ C �y� 2_�1 � <br /> i cl o <br /> PROJEC ADDRESS ; <br /> Owner � Mail Atldress <br /> , �'y StalGlia Phone <br /> `�h, e 1� . � f ' ` , ��. l�u! iv�err:l rr.e _ ku � � � r�•z. t �,i <br /> Tenant � ' ' � 'rC.:C,3 I <br /> 61ad Atldn:ss ���Y i <br /> Statc(Zip Phonu <br /> 1='1'��L'i!�T�il6: " �a' iSCr_c!� Litc� o C�'. <br /> . S". .1S C�.�✓� <br /> EleetnealCoMraqor i lnailAOdmss �i�, ��'� re `� �' ����1 Sa"� <br /> , Stala/'L�p Pponc <br /> 1 Ili !i '.ti S s/[j � <br /> Staie License Number(relquired) City of Everett�wmess License Number(reqwtedJ <br /> , � ` ' � <br /> rii ;�.�!; 1-a,.,..; � �1 � � I4:"s'7, <br /> PropoSetl U5e of Bwltlmc � <br /> � ContraG Price of Work <br /> I <br /> SquareFootage(Ifreside 6alnewconstruction, remode7o-adtldion �,Gmrt �= • \ F'nC'`'' •..• <br /> 1 Contact personlContac: Numberl[mml <br /> I •7.i3 "oJ/-.�t��'�OFII <br /> ' �i..,y�3.. .:�/– (�.2(• �j �{-i«'- <br /> � Number ol devices (If low oitage) ' � <br /> �f�4:t.� : � I;:le �.5y57.j'Li�!�e.Cl. Gcr��� <br /> II Descnptian o/UJork to Be�Done I '� - � � 1 . <br /> 11 S A.�� �� , ._) Y1CLil , n �_ .�r� � ;�r (fP-u-P <br /> FEE <br /> CITY OF EVER[iT LOCA �SALES TAX CODE IS 3105 � O QO <br /> I frereUy cr.rtily�haf I have r.���nd oramiaed Oiis appl/cahcn�nd know!he same fo be fn�e and <br /> correr,t fUl prr,visions n/I ris and orUin�ncns goveming this type ol wo�k will be r.qmpleled <br /> v+Ir�fher spec�fed hr.rcln oI noL 7he grantin9 0!o p�rmif Jocs nof �esurne lo ----- —1 <br /> P g/vo authonry fo p[RMtTn <br /> vrolNe cr cancMlhe provis ons olany o(her slafe or/or.al lavi regidaUn9 tonsfrurJion or tho / q <br /> pedonnance oJ consVuclio .; Tha(!am�ulfronzed Dy the otivner olfhis pmperty to porlorm!he E / Lf! Z— Q G S <br /> wo�tr lor v�bich applicahon s'maUe and I comply nrJA(hc Sta(e Con7rec/ors Law 7 p,27 RCbv and <br /> 29G 7D0 WAC. <br /> i <br /> � <br /> i <br /> }.�(,'.� •� . ' �, ' ru.� :� - /U ' ( �/ <br /> S�gnalwe � 1 Dale <br /> J <br /> RF.I•b:D afDv70t1 <br /> _–_.._ i "_ _`___._ _— <br /> l�d V;Ell69E9Z y�olswolsRgonqenouu� r.�Z�plVlll �Ap <br />