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� <br /> ELECTRICAL PE <br /> RMIT APPL�CATION <br /> CITY pF EVERETT PERMIT SERVICES <br /> 3200 CEOAR STREET, EVERETT, Wq g820� J <br /> 425-257-8810 - FAX 425-257-8857—w�nn,y.everetM�a.org I <br /> /2 --I( -�� <br /> � G 1 y iz-r�7/ <br /> V}� t� n�, r:'f 111� , ..�li (� r i3i�i � <br /> rnu�tCfi ADDRES$� ; <br /> li <br /> OwnP.r I � Naiiqddrea. <br /> i � City SIa1NTip <br /> Phpno <br /> y 1 <br /> '"111. i .,. � . �. �`��� 1�1er�r:l( , . k� <br /> Tenant � ' MailAddress ��z • v � a'ri'e. � Q,i rS.�C..� <br /> Ciy � Slale/Zip <br /> Phone <br /> 1-�'lUllrx��11 E �.. : +am � � .. <br /> Eteancal Contracior � s rtc � `' 1 '�s , ��-s fa,�,% �r y' !j�>i �r _L' l• L� �1�- 9a'3 5i <br /> Mai�Address C�ry <br /> � Slat�p Phonc <br /> 11�' �i�15• S's/3`� . <br /> Sfat^Licensc Numb,r(reqmreU) <br /> � City of Everett Business License Number(required) + <br /> , I �� ! � <br /> �lt u{_I, 1-c�•.r. iJ � �1_4:3'?, <br /> Propo„ed Usc of�mldin • - <br /> � Contrad Price of Work <br /> Square Footage(If resitlef�ual newconstruqion, remodel or adtlilion —4`�i`�r w ��F.' (� •'- " <br /> I � ) Contact PersoNCantac! Number�Email <br /> � ".�`..i:3"�J' ✓I'J'D�iJ PfP.II <br /> � '�,,,�1...'l.. .j.�!l— ���.(. L� r�iC.r <br /> Number nf devices pf lov� oltage) �n h��. �� � ,, .. � <br /> f:ll'lrc.�: �S . o��/ /��7.ct(. �-'uq��- <br /> Descnption a1 Work lo Be one' _ � ;}ti� �. C � ���ij �� :,r, � �� . 1Q � <br /> _ � <br /> I � <br /> f-f E — <br /> CITY OF EVERETT LOCA 'SALES 7AX CODE IS 3105 �O� <br /> !he�Ly certily(haf I have rhad and ex�mmed fhis applicalion on0 kno�v!he same�o be Inm antl � <br /> cor�ecL AI!provisions nfla �s and ordmar�ccs yoveminqlhis type of wak wdl be compleleci <br /> whe;herspecficd homin or not. Iho nrenling olo pcnnif does no!piesume 10 ryive authon� to <br /> wulale u cancel Ihe provis� ns o/�ny pt/7cr S�Bte or fncal lew mr�ulahhg conslrucfion orlhey PERh7IT11 <br /> pei7ormancr of r.onstrucfio .i That!am aulhonrod by fho rnvner o/tlris property to poAomr lhe E i y� I �- e� � <br /> ivoAc/or�vhrr,h appliCalion i, madr. anU I Comply wrth(he Stale Conlraclo�s La�v 18.27 RCW and <br /> 296 200 WAC. <br /> � \ <br /> I >(i,`.�� �. r[. / ��� - /U ' / �� <br /> SignoNre � Dalc <br /> - � - l <br /> p!V!5[G olL:.f.?OIa <br /> Z. �� bSE l LG8£9Z yool swo�slg enqr.nouul �l0 E0 b l Ol �A4 <br />