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� <br /> ELECTRICAL PERMIT APPLICATION <br /> ; CiTY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-Z57-8810 - FAX 425-257-8&57—��.e�rettwa.or9 � z --���f y <br /> Ci4iz�D7Z <br /> `I11 ` ��� o , �II '� l bI <br /> I PROJEC ADDRES � <br /> � ' <br /> OVmer I i NailAddress <br /> � C�ty SIa�M2ip p��� <br /> . I <br /> '1h..11:��rl-�r, r1' 11f�'e.�r� I � I` �r , (� I�lc� I��C�^hl! (� rP � I� liht F �tir Y 1 <br /> renant � f k. F} � k ae 3 <br /> Na I Addms ��h, <br /> Slatc2ip Phonc <br /> Z� �i�v'nf�iitc " - te �s rc�� �r.�. • �--, c—. � <br /> Electncal ConUactor j -'� _LS Q.,.,. .�$�' �,,. � . � f i.t J1�- �IS"3 i/ <br /> A�talAddmss Q1y St�IcJZip Phonr <br /> ' �r's��3y <br /> l�(l./l):�l)S <br /> State�icenSe Number(r qwred) <br /> � City pf Everett BUsiness License Number(required) <br /> � , � . ' I <br /> Proposed Use of Builtlin <br /> �,437,�' <br /> Contracl Price o`Work <br /> Squ2re Fcotage pf reside 6al new conslruction, remotlel or atldiGon -"�"nr� �� • � h' n C �-• �- <br /> I 1 Contatt PersoNConlact NumberlEmail — <br /> � ��.63-ro.7l-��'.y.� oF_rl <br /> i . U.ti_'.. ^t`)/� i326 iJY{-�cr. <br /> Num6er al dev�ces (If low 4oitage) i�1 n�U s. S 7��i y (, <br /> L lll.l..� � � ��1�. (�Cr�'�- <br /> OesaiptionofWorkloBe one' � f\ J�'q_+( ��. ^ j ��C�� il � I } JJ- <br /> - I � <br /> �, FEE <br /> CITY OF EVERET7 LOCq SAI.ES TAX CODE IS 3'Iq5 G /'1� <br /> !noroby ceRify fhaf f havo faad and examrned Ibis npplicalirn ancf know 7he samo lo be frue and � v <br /> correct. AN provisians ofla s and ordinances goveming fhis type aI work wiff be completed <br /> �vhelh�r specif,cd hercin o riot 7he granhng of a pem�it docs not pmsume fo qive aulhonry to ptRMR�' <br /> violaf�orr,ancef7hep�ovisr nsofanyothersfateorlocallawregulafingcensfruclionorlhe <br /> pedormance of conslruGio ..' 7haf I am authorizeAby(he owncr of fhis property fo porlo,m the E �y" � 2 - U'�1 Z <br /> work lor which applrcetion i•'mado antll compty with(hr.Slatc Contraclors Law 18.27 RCW and � <br /> 296.200 W�C <br /> �, <br /> 1C•....���,t �_ ` / . <br /> Signatwc �J� � /U ' / y _ <br /> (I OatC <br /> nev�stuoxacaou <br /> f; d 49E11G8£9Z 4�e�swals,(guni�enouul �l0 £041O1 �.�a <br />