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IELECTRICAL PERMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />I, 3200 CEDAR STR�ET, EVER[TT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vn+n�+.everetlwa org <br />I <br />��1 \ � 2�c.1�e �e 1 �c,,� <br />PROJECT ADDRESS �ir��"� � w`� 5�"3U 1 <br />L�l YYIQ'-t.`•.,\�( �i,¢.c�% <br />0'Nner h1a�l AdCress �''Y <br />Tenanl <br />Mad ACdress <br />,; <br />Elecirical Contracior lda�l Add�ess <br />�'�0�0 SSQ � a.3 00 <br />Slate Licansc Number (requned) <br />� � � �' 1-, <br />Proposed Use ol �wid�rtin � <br />Ciry <br />t�� .^1�� k, <br />ISquare Feolage Qf resldential ne�v conslruclion, remodel or addition) <br />Num6er of devices (II low voltage) <br />City <br />1` �%—�S <br />C �Sa/-/J� <br />SlatelZ�P <br />StatelZip <br />Sta,elZ o <br />Phonc <br />Ph:ne p <br />D <br />/y� 3 <br />Phene <br />�3� 1 <br />Cay o! Eveiett Busmess License Number l�equired) <br />� i \_ _ . <br />C ontract Pace o( �Vork <br />Contact PersonlContact NumbedEmaii <br />� � ,� ���— ��1e �"''— <br />DescripUon of Work to Be Done _ � �`�'L _����^ � <br />_����tit,�' -- - ---- <br />PEE -- <br />CITY OF EVERETT LOCAL SALES TAX CODE �S 3105 ^ 5 D� <br />l hereby certily fhol l have �cad and examined fhis . ppllcafmn nnd hno�v fha• sirne lo be frue ancl __� —. —__ <br />conecf. All provisions olluros and ordu�ances goveming this (ype ol n�urR �v�ll be r.omple(r,d <br />whefher specilied herein or nof. The gianhng o( a pemiif docs nof piesume to yivc aidha�ry fo pERhllT7t <br />violale orcancel the p�ovisions olany ofhersfafe orlocal i��v rogul�fing construr,fion orthe �(�O I <br />� <br />pedonnance o/ tonstrucfion That 1 am aufhorized by Ihe o�vner of (his p�opeAy to peAorm Ihe � � � <br />�vork for �vhich applicalion rsJ,f�aoc nd 1 wmply �•idh Ihe Stalc Contrac(ors La�v 18.27 RCbt� and � --- <br />?9G2001NAC. I (-1 / � <br />i - a -�- ��— <br />�:ib,gtD030✓'01: -. . . -__— _ <br />' _ ___ . . __— — _-- _ _ _ — _ _. <br />— —'__ ____ <br />..—.__ _—._—_ <br />� . _... ---_.—. " <br />