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� � <br /> . ELECTRICAL PERMIT APPLICATION <br /> � CITY OF EVERETT PERNiIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wq g8201 <br /> 425-257-8810 - FAX 425-257-6657—�yWy�r,everettwa.org <br /> � /Z`,/ �� � I <br /> �`� . . � C�l�fi2 -��� <br /> 1`'�o ' ' .l ��� ^ � • 1 S' <br /> PROJEC AODRES <br /> � 1 <br /> OwnB� Afail Atldmss Ciy <br /> . StateZp ph�� <br /> ,"lll. ' 'e, r'� ,., \ , L. �`r�� P�CJ'f•�� . Y'Ce L �', <br /> 7enant � � �u�� drr'e.1�' (1,)F� 4k�u 3 <br /> � MailAddress Ciry <br /> . Sfatc2'rp Phone <br /> _. �n�) )0.l' 11&. �. . ' 8'n7S'C�C.� �11C� .a��S' S� LS CL�.,j . <br /> ElectricalConirador ' a`: �?': « �� �Cll+- �J'� �1 <br /> - Mail Atldmss Ciry Slaic2p p�o� <br /> I <br /> iN 'n; s S y!3�/ � <br /> Stale License Num6er(r�qmretl) City of Everett Busine5s LicenSe NumCr.r(requireC) <br /> � �'1��t37,�' ' <br /> _itl.�fl ' l-a-„�� I � <br /> P�oposed Use ot BudOin � <br /> ; ConiraC Pnce of Work I <br /> i ���� <br /> Square Footage Qf reside tia!new cor,truction,remodel or adtlition �'u't'II'�����``. �'F�� t•t.y�- <br /> , ) Contacl PersOn/Contact Number/Email <br /> ��?-�.�/-�3 Y�C?��rl <br /> � a-.• <br /> �.53• ��?l- f;yaG � GF�c=- <br /> Numberofdevices(I(law ollage) �11.1;��� ; innr_;���:�57$�iy-'Lii_i:.l, @c,��.. <br /> Desaipl�on o1 Work tn Oe onc. 1�� S�•t� ��_�,y���j � �� __�.� I U c-�1 f t <br /> � ��, <br /> i <br /> FEE <br /> CITY OF BVERET7 LOCA �SALES 7AX cODE 1S 3105 � � OV <br /> I hCreAy ceitiP�lh��t l have ead and examrnr�d lh�s e �' � •�� <br /> pp.�cation and know(he same fo Ae bue�nd <br /> correct. Af!provisions ol laI�s and ord�nances govemrng tbrs type ol woik wdl Ge comp/eted <br /> whpfhei specifir.d hcrein oq noL 7he grdnfiny ol a pertnd does not presume fo grve aufhwi fo <br /> vio:ate or r.oncel the provi,.lnns olsny o!he�sWtr, orlocai la�v mqul�fin�conslmcGon or tho �ERMI7Jt <br /> pnAormance oI consfrucliun.� 7hat I am authnrizod Gy!ho ovmer o(flns prope�ty�n peAonn tne E , � I "� _ �� � <br /> �•.ork for wh�ch application��madr.and!compfy wrth fhe S(ato C�nlractors Low 18 27 RCW and <br /> 2�s.zoo wnc <br /> : <br /> � J�i,'IMA�A i_ ��-(il q.�i � � � �V " / �� <br /> Signa�ure i � Dalc — <br /> 1 <br /> RLYItiEfiORq(/�p�1 j <br /> � �_ ._--__` �_ <br /> 1 <br /> I <br /> � d b9£l lG8£SZ 1{D9j SIUA)5/��j` 6AI)F?AODUI dZ0 £O Vl Ol �A0 <br />