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ELEC�ICAL PERMIT AP�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 37_00 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —v�nvw.everettwa.org <br /> I � I6-�� <br /> [ isni� o� j <br /> Z�s' /��i�/e si <br /> PROJECT ADDRESS <br /> /U/� .CSC.'��/�O/✓ 7f�'� �./� /p/' S� �Pi/1e/� Lv/4 <br /> Owner 61ailAddress Cily SlateZp Phone <br /> Tenant tdail Address Cily SlatelZ�p Phone <br /> ',�/�� �i�1L,/ ���c.,� /7.� S'ti/ /YJ/J.G'��O �t/� ioG�S� �ZS- %�3�.SY�� <br /> EICCtrical COntrar.tor Mai1 Address Cily Slale�Z�p Phone <br /> /7ArrPss 9s/.e9 ����o� <br /> Slale License Number(reqwred) Cily of Everelt Business License Number(requrted) <br /> Propose0 Use ol 6uilCing Contract Pnce ol Work <br /> Square Poolage Q(residential new conslruction, remodel or adddion) Coctact PersonlContacl NumbedEmail <br /> Number ol devices Qf Iow vollage) <br /> Descriplion o1 Work lo Be Done ����� S�i2v/�-P,Q�✓C`. / -.7� ��'/'�C <br /> ��LG �GYf�//�J/�/ " /C,P,��d1.t°, /�/✓�1) Zi.�S�/��� — <br /> FEE <br /> 5 p0 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � <br /> I here6y ceAily Ihat I have read and examined fhis applicafion and know the same lo be Irue and <br /> correcl. All provislons o(laws and ordinances goveming this I}�pe o/�vork ivill6e completed � <br /> v�hefher speciGed he�ein or nof. 7he g�anfing o/a peimil does not pmsume lo give aulhonly fo PERMITtI <br /> violafe or cancel fhe provisions of any other sfate orlocal la�v regulafing construcfion or7he E � �D � _Dy 3 <br /> � perlormance of construcGon. That I am aufhonzed by the owner o/fhis propeAy lo peAonn the <br /> work lor�vhich applicafion is rnade and I compfy n�ilh !he Sfafe Conf�acfors La�v 78 27 RCW and <br /> 296200 WAC. <br /> , 7 � �i/ /�/5 <br /> 'ignatu a Dale <br /> REVr5E0 oah�SRo;a —.—_ <br />