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i- - - -- --�- -- — �-- -- --- --- � <br /> i <br /> ' ELECTRICAL PERMIT APPLICATIOIV ' <br /> I� CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREEf, EVERETT, WA 98201 <br /> I 425-257-8810 - FAX 425-257-8857 - www everett�va.org �—/a —I �( <br /> � Ci�foS-o� ' <br /> I <br /> � /So Z - �.r �An -�� ll,�, ��� <br /> 'I PROJECT ADDRESS <br /> � �'ileT ILQo�, ��Qe ��lev., IS�2 4k,��,� �Il<n W-�e e�eeerr �Jc� `j $Za � <br /> � Owner t�7aJAddress Gty S1ale2ip Phone <br /> I <br /> � <br /> ITenant P.tad Adtlress Gty State/Zip Phene , <br /> , 2 o(a SI'-r I <br /> I �—v�-�-� `' ����-� �•n� �9 �4 - 22G�� S� L�ncu��; �n�iTk�eQac¢ Wo- (�0�13 7505' I <br /> li ElectncalColur9cicr �:tadnddress Gty State2io Phone <br /> ' (� � �zl �ei � �5� s� �LS � 3Z <br /> � Slate License Number(required) Gty o(Evere�t Business License Nurnber(required) <br /> �� �� �c�; s��l z.So �_� � <br /> � Proposed Use of Bmlding Contracl Price of Work <br /> � <br /> 1 Z o� v�r<< ��� l �,,� l< -� 20 6 Pi.�_�5 o s <br /> Square Poolage Qf iesidential new wnstruction, remodel or adddwn) Contact Person/Con!aU umbedEma�l <br /> I <br /> I <br /> Number of devices(If low vollage) <br /> `'�����C' R'�-e.- <br /> Description of Work to 8e Done �--� Sel� J�� �-� � ` � ` "`� ���'��� �t� ��__. <br /> G�-� eS ����-• I c.��r�eS1.� �� _ 1�� �j��w U.� �r �c � �e�� <br /> FEE <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS J105 �O C� <br /> I hereby cerhly fhat 1 have rcad and exarnined Ihis applica6on and kr;oa the same to be(nie and ____ <br /> correcL All provisions ollaws and ordmances goveming(his type ol worh n�ill be complefrd — <br /> whefher speci(ed hcrein or no�. The granGng ol a pemut docs nof presume fo givc aulhonty to PERM[7�N <br /> violale or cancel fhe provisions o/any othe�stafe or local law�egulahng consln�cfion or fhe ( <br /> perfommnm oI cons�ruc(ion Thaf I am aulhonzed by the ownerol Ihis propeRy fo perlomi Ure E � �O� _ 0 g I <br /> worh for which applicafion rs made and 1 compty�vdlr (he Stafe Con�rar,tors Law 78 27 RCl4�and <br /> 296 2C0 WAC <br /> C���.�___�,��X �� i 1 , � </ <br /> Signature Dalc <br /> ��_ <br /> Re.�5=c oav5^.�i a <br />