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I <br /> . �LECTRICA►_ PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wq 98?_01 <br /> 425-257-8810 - FAX 425-257-6857-www.everettwa.org <br /> � / �� '�` � � I <br /> ���� ��1�,�n,t c�f i11a '11 (� � J RrA� G. � I �( lZ TJ7y <br /> i <br /> PROJECYADDRES� ; �� <br /> � Ovmer � <br /> Mail AdAmss ��, <br /> SIa1eJ7ip P�onr <br /> �1�'�� :� n c� ' �e- � 1. '' c �G. �"�U' P��C�''f•�I � Y'L'c �° ��hi <br /> Tenant � tota�in�dmss �v � a'ri e.f*r (:.1 f} %�.�0,i <br /> � <br /> C�ty S!atc.'Zip Phone <br /> -L-+���\Ui,'rCI 'b: ' ,dvY75rIL�� L:1� ,35. C15 a,.,l � � c <br /> Electncal Contractor 3<' r_ rr �� �t i j �b� <br /> Maii Address CRy SlatelL <br /> P Phonc <br /> iNNui�s7'yy�3 � � <br /> State Licen4c Number(r�quired) City of Everett Ousiness License Number (required) <br /> i <br /> ' i � <br /> � dQ � /'�r�3�� �� f <br /> Proposed Usc of omw�ng� � ` <br /> Contract Pnce of Wo� <br /> i � <br /> Square Fc�lage(If reside Ual new Constructwn, remotlel or atldition ( ` � � �- S�F�^ �� •�-� v <br /> � i ) Contact Person/Contact NumbeNEmail <br /> �J53-0•>/-�h'�.i CC!�_�l <br /> � . .�l:i��.. p��/� 1d1� UT{-�Cr' <br /> Number ol Cevfces pf low oltage) �pqq,� : i n nc��.i�S 7'�G�y�i�:u l, eon�- <br /> �escnpt�on of Wnrk to Be one: j_ �•, ��-q �( '��2 ��u� � .� <br /> -��i ) U• I'�2 �_ <br /> i <br /> FEE <br /> CITY OF EVERETf LOCA SALES TN(CODE IS 1105 <br /> 1 hereby c�rlify thaf/have��d and eraminetl Ihis opplicafion and know fho same fo bc lrue and v � � <br /> cnnect. Af!prov�sions of 1a vs and ordinences governing 7h/s fype ol woAc wi11 De r,omple,ed <br /> mhNher specified hrirein or�a. 7he granling o!�peim�t does not pmsumo fo�ive au(horiry fo p[RMCP,� <br /> violofe or canct�f Uio prov�s ns ol any other sfafe orlocol!ew n:guiating consfroclion or tho <br /> perlormancc qf conshucAo .! Thaf I am aufhonzcrd by(hc owncr o!(his pinperiy to poAorm fhe E I t-�- I 2 —�� � <br /> worh lor vihich appfrcofion i inndc and f comply wifh 1hc Sfafe Contraclors Law 18.27 RCW anA <br /> 29fi.200 WAC � <br /> � ' , <br /> ,JL�) '. ' :� ' r[�� in� !�� - /J ' / '-� <br /> n <br /> Signature � � i--- nale --' <br /> HCVISC-DOA9.47pf1 <br /> S'd VSEllff?£5Z ' 4�e1swe�sRgenpenowy �LO-£OblOt �oCl <br />