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� � <br /> _ � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br /> / a-�-�'-�y <br /> C l �lZ—/(o � <br /> �300 /UI C,rR� � L L. CK LJL I� ��W y <br /> PROJECT ADDRESS �p� <br /> ��� ���k���-�- ti�.e l� ��,.r ; JPrs�+-.� St -� a��d �Sa��/e �.,p. Gi�3 -53oo <br /> Owner MadAddress ity Stale2�p Phone <br /> �J�5 <br /> L✓R�ef�e�-�an�� [ �Q �✓1LJ��1l� CK �l;w� �J�e� c,��a . 3y9 N�ov <br /> Tenant ��7ailAddresS Cily StatelZ�p Phone <br /> � 3l00 <br /> ����,�cv�A��G. LP %��/.S-r� 1���s�Tr..��� �Q /YIUU��ULr�/UbiJ W/4 tia� v�95 <br /> 6ledricalContractor Ma�lAdtlress City Slate�Z�p Phone <br /> s�q � �� L� ��s� �� ��1a99a <br /> State Licen�s Number(required) City of Everetl E3usiness License Number(required) <br /> `�r1,DO� <br /> Proposed Use of Building Coniract Price of Work <br /> 3�0 <br /> ` �� ����so� �ia� � �� 5 <br /> Square Foolage (I(residential new construction, remodel or addilion) Contact PersonlContact Num6edEmail <br /> Number o(devices(If iow vollage) <br /> C WI`�IIJIJDU�JT C�{�An1NeL_ L,(�'��S l+ -�`. � <br /> Descriplion of Work to Be Done: J�q� — <br /> -� I)UWI �� Fl,� �o �� — <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 !�/1G� <br /> ../(J <br /> I hemby cerfily fhat!have road and examined Ihis application and know(he same fo be We and <br /> correcL All provisions o/laws and ordinances goveming this(ype o(work will be complefed <br /> �vhefherspecified herein ornoL The Qranfing ol a permit does nol presume to give au(honty fo FERMIT:t <br /> violate or cancel fhe provisions o ny�bfher sta(e or local law mgulating consfruction or the r I �� � J ���/ <br /> perfonnance olcons6uction. iat I m authonzed by fhe o�vnerolthis property to perlomi the t D <br /> work for which applicafion i mad and 1 comp/y�vith fhe Slate Confracfors La�v 18 27 RCW and <br /> 7.96 200 WAC. <br /> �a/3d��y . <br /> Signature Date <br /> REV6ED 06D6?O1C <br />