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� � - <br /> , - -- - _1 <br /> � LECTRICAL PERMIT APPLICATION <br /> C�TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wq ggp01 <br /> , � 425-257-8810 - FAX 425-257-8857 -www.everettwa.org f Z--� � <br /> � �� � � <br /> C�y�2 -��3 <br /> y�� � o nii �� f11�r�r,l( (��� .,. _ � �— <br /> PROJEC ADDRESSI � <br /> I � i <br /> � <br /> Owner Nail Atld�ess <br /> � ��N Slald2�p <br /> PAono <br /> 1n_,Il.rri-n . ,.•1- li�� .rr� l � (` n- e.��_ �`�c'f (��E�^fi � F <br /> Tcrant � . �� � 1^c' � �. ' �SIi��L_�tlti�f� l[.�f} �IK �C '� <br /> ��ndtlre s ���Y <br /> SIa1rJZ�p Plq,�c <br /> 1—��V\U�;CiT�I(c' � � I � <br /> ' �(Pill.i �'ZG�� ( 11L � �3.�J i_,�.1_S�Qn�J 1�1^j� f]<'!)/IC/ i f � <br /> EiectnqlContracta ' IdaiiAndress ui1�' ��' -� �/ <br /> , ��ry SlalefZp Phonc <br /> 1 lli ���'.:, S'.c�C�� <br /> S!ate Licerse Number(r ' wred) <br /> Gty O([verett Qusiness License Number(requiretl) <br /> � �r 1 <br /> 1.u��-1; �-n. , I u � E l.4 3'7, <br /> Proposetl Use ol Buddmg � <br /> Conf2d pnce of Work <br /> � <br /> I oquare Foocage pf residerhUlal new construclion, remodel or addition �li�lr��--�F^ ' • '� <br /> ) Contact PersoNConlact Number/Emad <br /> ���3-r�5/-�5•y�C�r�l <br /> � � �:.53. _�?�—�a;�c � { 4=���- <br /> Numher oF devices(If low oilagg) y- ��ri`l. n� <br /> Gn�c.l : rnlit� s t75/• � � eu <br /> Oescriplion of Work to 8e ona 3 � ���Z � ^ � � <<� � � _ � iJ �. d�_r <br /> i <br /> i <br /> � FEE <br /> CITY OF EVERETT LOCAL SAl2S TAX CODE IS 3705 �O O� <br /> I ho�eby a:ililylhB(I/rave rCI ad nnd ex�minod�his appllc:�Gon and know lhe samc fo be frue and <br /> co�roc7 Alf provis�ons o/Ia:�Ls anJ ordinanees govormng(liis t}pe o/wak w�ll bo compleled <br /> �.vhethe�speufed lierein or�por 7�re granlmg o!p peimif doos no�presumc ro�ive authonty lo <br /> vwl�fe a cnnce!fho prpvisiyns d any o�her sfa(e ni locoilan•nrgulaling consfrucfien or llre �ERMITk <br /> nP��o�nance or consr�ucr,od� That I am oulhonrad 6y Ihe owner o1 this piopoity fo por;orm O�e E � 4 �� ' o�3 <br /> K'ork�o�whrch applrcation i inoUc unU!compfy wilh/he Stafe Conlraclors Law 18.27 RCW antl <br /> 296.200 WAC <br /> ��=(`',1ti,t.1�,�. ;"C^ ' /r�' - /U - / �/ <br /> Signalure � / <br /> �l � OaIC <br /> HEvi;,Fn aaa,i�ra <br /> __� �_�� <br /> V d v9Ei lG4£SZ yoolswe�s�(g oni�enouul �l0 E0 �l Ot �o� <br />