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��4ay. 1. iDl� 1G:16A6�1 <br />�Jo.9Gn1 P. 2 <br />ELECTRICAL PERMIT APPLICATI(3N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425-257-8857 - w�w�.everethva.org <br />� <br />_?; ���`�- }�,s��-Fel(�y flv�e., <br />PROJECTADDRESS <br />Owner <br />Mml AdCress <br />c�ry <br />J --��„� � <br />� � �5v�� � <br />Pnono <br />I <br />SUMVt4 :_E/ ��3� a` DCf[�>�I L�c. ��— �d � �i�l I �Z1 - �IZZ,- 7Z3`-I <br />Tenant Idail Adtlmss Gily S���eZp Phann <br />Electncal Conlrador -� �dailAddicss <br />�� ti riT�� i H R�t) i2FL <br />Slate License Number(roquircd) <br />Proposed Use oF �ulltling <br />Square FuoWge (If residenUal new consWcOon, remoJcl ar adtliuon) <br />Numbor of devices (If low vollayo) <br />DuscnpGon 0� WOik lo Eie Upnr� <br />CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cdy <br />S1al�2ip Phone <br />�,�"I �p ���- <br />City of Everett B�siness Ur.ense Numher (requlred) <br />�(J-D0. 0 D <br />Conlract Price af Work <br />�L!.s� �s�L'KNO � <br />Contact PersoNCont2ct NumDorlEmail <br />_w-�, i,T,� �u�rnaC.ey Y-�-(�l�is'-�- <br />n <br />�WY�LL C Q.. <br />I heroby cortily Ihaf I havv ruad and oramm�J this appGcalion ond know fhe some fo Ae Vue and <br />correcf 4U prov�sons vlliiws nnd oM�nances povemrng fhis lypn nf work wiN bo wmplefod <br />whethc�sperihr.d hr.min or noL Thr, p�anfing o!a pennif doos nof presumo fo givo aulhodty to <br />v�ol�fc or canr.r.l fhr. prov�sions o! any otAor stafo or local law ruyWafiny consfrucYion or 7Ne <br />perlonnanco o/ consWcfion. lhat I am autho�ized by the owne� nf tBi, propehy to perfomi fho <br />work for which appllcation is made and I compty wi(A llre Sfato Confrar,las Lnv 18.27 HC W and <br />296 200 WAC. " <br />S�grndure Uatc <br />rrm�Fn annrso ia <br />FEE <br />� � �� J <br />P[Rh11TR <br />F.�l `� 0 5— v0 � <br />