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05/17/ �015 20 ;2 «G726 F 001/001 <br /> . ELECTRICAL PERMIT APPLICATION <br /> CITY f�F EVERETT PERMIT SERVICES / <br /> 3200 CEDAR STREET. EVERETT, WA 98201 S-1 � `�S <br /> 425257-SA10 - FAX 425-257-8857 –www.everottwa.org �� <br /> �/505_ <br /> � � oZ �2 0 �k�i �Fi L�fE� 3� 6 <br /> PROJECT ADDRESS ����� ��� <br /> ��,.�t � r rc.n_r�E 9'q 3/ Y 9'` p�L l�(� ��i�% � ° y3� <br /> OWner 61ailAdtlrass Clty Slaie2ip Phone <br /> Tenant Muii hddross City StntnRip Pnonn <br /> � ���� P�.r �� �� i y�r ��� � <br /> /!/ ���� � <br /> ElOctrical Conlrnttor Mail Addrrzss Clry SutR/Lp Ahonx <br /> �'��ivSf i V � r P �� ���,����lZ1..i° r� ��3G � <br /> Sta�e License NUR1DOf(fOqwfed) City of EvOfOR BwiOBss canse Numhe�(reqwNd) <br /> S�/4 <br /> Proposod Uso oi Buildin9 Contrect Pdcx of Worx <br /> Square Fcmt,igo(II rosidonifal now constnir.tion,romoaol or ntldition) Contact PersonlConmct NumboNEmail <br /> NumDar a�dowces(If low vottngo) <br /> DxscnpUnn of Work lo Bo Dono: e�r ��fU' U���� !�a���n � <br /> Ca n � — o1�A�l��.r t���f��l-r^1� /�lL�h�lrl4� <br /> FE[ � / On' � <br /> qTY OF EV[RETT LOGAI SALES TAX CODE I&3105 �l / v <br /> /V <br /> I hr+rNGy cert�fy 4�uf l lurvx ro�id onAernminod fhis nppUr.a67ui nnd knnw fho snmo!n bn Irun nnd <br /> Coiler.f. 4fl proNsions ollnwx nnd oNumnr.ws gnvnming Uvs fy�w ol work wilf be mmpfntnd <br /> whnUixr r.�x+eifieid hert+in or no/. Thx gmn6ng o/a�wrmr�does nof prosumx to givo mdhnnty fo PERMITk <br /> violato or cancel thn pmvi.cinns o/uny othxr sfatx m Iocn1 inw�xQWa6n,q coi�urucfion n�Ihn � _I ��� _ I O� <br /> poAonnt�nco ol Cansfrucfion Thnl!nm siulhnnzxd by lhp ownwr ol(his pmpndy to�x�dnrm Ihn � <br /> work/or whicA�pp rco on is madu and 1 comply wdh fhe Stafe Controctors Law 78.27 RC W nnd —� � - � �I <br /> 296.200 WAC. <br /> � � /�f' S <br /> S A .tix �__'_' � <br /> RBViSC SA:DN <br />