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� <br /> LECTRICAL PERMIT APl�LICATION <br /> ; CfTY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257• .810 - FAX 425-257-8857-wayw,everettwa.org I <br /> � <br /> ; /Z ���--�y <br /> "i� � , �, ���, � ' ,-i� � � _ �- : ri C-r4rZ o�9 <br /> IPROJEC ADDRES <br /> Owner Mail AAdress <br /> I <br /> C��' SIa1WZip Phon> <br /> .��ll.l �.nr�n , c'�- li\ern� li �� r l� I`/�� 15�C� f �� (� �2cN F�, <br /> 7enant ' . adnadress ��� � ✓��i e•�� lt1 F} yX�C 3 <br /> Ciry Slatellip PhonC <br /> .L':�ll'1(!i':.. �i : _ �, ts Tt.�. G�.> > �s�a �/i� f3v7 ir � / / u Il�- Sb <br /> {,' b. v�- 1'i:� �r-, C`' � c, i/ <br /> EIeC ncal Contrector � Ma�i Addmss � <br /> ' �'�Y StaleZp Phone <br /> i <br /> 114�1.�:i�f,S'�S'Y/l'J � . <br /> Sta!e License Number(r�quired) Crty of Everett�usiness Licerse Number(requirec� <br /> : <br /> -�� � � �1,4��,�, � <br /> Proposetl Use of Buildin <br /> Contracl Pricc of Work <br /> I <br /> \ <br /> SquarC Foatage Qf reside tial new Constr�ction, remotlei or atlditlon '�4"�`r��, � Y �' � ` v <br /> ) Contact PersonlContaq Number/Email <br /> I I ..�3 -!�J/-_i\�Yi ON_f� <br /> + I � ,. <br /> Ud�_ .a�il- i3aG � h4-�c�= <br /> INumber of devices pf iow oliage) t I1lc.� � �n rlc����S ;�G�yLw4/, L�.�.,,_ <br /> � � <br /> I �esaiplion of Work lo Be ane: �. �1 j����� ��-,.^ y ���•; � � _ I . y <br /> --�__ :_i'. ii i.�til Ct4-L <br /> I <br /> i <br /> � F[E <br /> CITV OF EVERETT �OCA SALES TAX CODE IS 3105 � n � <br /> 1 hcreby cedify thal l have ead and exarnrned 7his aoplitafion anA knor✓fhe same/0 6e Irue and U <br /> cormct. Alf pmwsir,ns olla�vs and ordlnances govemmqlhis lype ol work wii!be cornpfeled <br /> whefhr.r spoci�ed hcr>_in nr not 7hc gnnfing ola pertnif does no!piesume to,qive aufhonry to PERMI?� <br /> wolafe or canr,e!fhe p�ovis� iis ol any olherslefe orlor.al faw�tqulatiny conslructron orlhe <br /> pedomiance oleonslructior.: Tlral!am nv�honzod by'hr owner c/lhis propurty fo pr.rlo�m pie E � I � _ O� � <br /> v�ork lur which�pplicaGan i mode and/compry wifh the Stafe Contracfois Law 78.27 RCW�nU <br /> 296.200 WAC. <br /> :� i <br /> � 1 � � � <br /> � ,c•� ;�. �--.�— l � - /u - IY <br /> Stgn�tur� � � IJalc <br /> usv�5R1 o6tr✓.wta <br /> Ol'd b5£llGB£9Z L{�A1S1116�SR�j`9A1�BAODUI dE0'E04lOL �eO <br />