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� � <br /> LECTRICAL PERMIT APPLICATIOIV � <br /> CITY pF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> i <br /> 425-257-8810 - FAX 425-257-8857-wv,rw_everettwa.org <br /> I <br /> i <br /> � �Z �/� ���. <br /> J�� '10 Bn. ' ( �1 <br /> ; �. :,� c�o (� C Il�/Z��G <br /> I PROJEC AODRES : <br /> i <br /> Ovlfl�f � tdailAtlOr�55 <br /> �� SlateJ2ip <br /> Phonc <br /> y��. �T. ` lc�^r,l r � , <br /> Tenant 1 , L_ I'-/�I I� � C e �.. ��S ,i � i,r;'r� t' 1 i c�> . <br /> I Ah�i�Mtlmss C�n, lt • b.JL� � <br /> . StatelLp Phonc <br /> i <br /> 1-4�V\Ul�n.'�tUE' ti . 2 t5�Cf_c �'11C.- � <br /> Efectrical Contractor` � �'jS i.^ � ~ a,•`� � � ��:•� ,c� ��i • o. I f� ��;' � .^ I <br /> t�laii Atldress Cily <br /> . Slate2p Phonc <br /> ir� �� s y�r3�/I <br /> Sta1e Licen e Number(r quued) <br /> City of Evercit 8usiness License Numbcr(required) <br /> � f ' ��1 <br /> �i. ,i4-1; �-c� �., P1.437, <br /> Nroposed U..e of Bwld�n� -- <br /> : Coniract Pnce ol VJoik <br /> `\ I <br /> Square Footage(I!reside Gal new construdion, remodel or addition �-�{�`-L=��ti � f��n C •c• -- <br /> ; ) Conta7 P�rson/Conlad NumbeN[mail <br /> � i ).�,3-(��/-,�8-5'.� C'r1•t(I <br /> ' uJ?. .�,<��� �:}:Z� L� �i'�C�'- <br /> Number of devices(If low oliage) L i}��, � ri ilG�� � �� 7,y'L/y�i,l4(, i <br /> � � Lcn�- <br /> f7escription of Work!o Bc Oone� j. �� 5{.��� <br /> l l�F •?l�t�i ��c.�l �!Ull0.��-� ' <br /> , � -- I <br /> I � <br /> � <br /> FE[ <br /> CITY pF EVERETf LOC L 5ALE5 TAX CODE IS 3105 �O �� <br /> 1 helC'by cBrti�'�llraf 1 have e':xi and examinr_d Ihr.;,�pp/ica6on and hno�v(he same lo be true and <br /> coimc(. A7/provisinns ct I �vs orrd orc}mances goveming Ihis type of wark will be cemplefed <br /> wbelhcr specdied hr,mm o �joL Thc granf;ng ol a pr,mnd dor.s nof presume fo give aufhon fo <br /> violote or cance/Urr provi, ons o/ony r.p�Cr sfalo orincal law regulafing consWcfion or Ibe �'EP.MIT# <br /> �'���W�'Ui app�c�I on made and I complyetirlh lh�eeState Cnntnl clors La�1 p 27 RC1W�d <br /> � E � �-I la- 08 � <br /> Z96.200 WAC. �___ <br /> i <br /> \ �iG� , Ju. � ,1 : ` , <br /> s�gnawre � � " /Date/�I - I y <br /> J I <br /> rrcvuc�n narosooi. <br /> /l d VSf;I 1G8C9Z yoo� swc��s/g enqenouu� dg0 £04l OL �AO <br />