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ELECTRICAL PERMIT APPLICATBON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />�� D� s ����' �-- �-��-� �a o3 <br />PROJECT ADDRESS <br />�h <br />Ownor <br />Tenant <br />�MIIAddress <br />�dall Address <br />ciry <br />C;ry <br />stntel2ip <br />Stalc2tp <br />gc. ] �-Is <br />�� Spg..��� <br />Plnml` <br />Phonc <br />&1Mn1a-►�. L�n.-hrq y bo� g �a�-►'� ►�L svA�l.� wo. 9�6� �8 aob a�l a�� <br />Elechical Cont2ctor Mau Addrm,s c�y StaWrz�o Phona <br />��Aq�a� <br />Slate license Number (requi�ed) <br />Sti- iZ <br />Pro�srrd Use of Building <br />SQuare �ootage (If msidentisl mnv construcfion, r¢modcl or addifion) <br />Number ul devices pf irnv vol(agc) <br />Ot Work 10 Be Uonr.: _ �_ ^l.( �- <br />L� ri. ) l Y�(a <br />CIIY OF Ey[RETT LOCAL SALE9 TAX CODE I5 3105 <br />oa �� 3 0 <br />City af Evemtt Businc,s Li:�n:,c Number (rt:puirrd) <br />�'3� <br />Contrad Pice of Woric <br />.�1� fY���L l{oW Ol„ 'a `� g•� 00 <br />Contact Per5on/Contact NumDerlEmail <br />! ficroby ecArfy (hxf f havc 1�qd end cxnt:�ined this appfitotion and know fhc r,�mn to bo frt,c ond <br />w�rect Aff provision; ot laws and o�nances govhming fhis typr, uf xtirk wil! bc complefeJ <br />whelhcr sp.+r.ifiod hemin or nof. R�c gmminq o! � pcm�i7 cfous no! presume !o plvr. aurhority to <br />violr,to or conccl N�u piovlslons ol any othcr steto or locnl fnw rogufating consfnictinn or �h� <br />pr.rlormance ol ct�n;irucUon. Triaf ! mm �ufhomnd by rhe awner o/ this properfy (o perfuRn fhC <br />wOrk IOr which applicofion is madu and 1 compfy wlfA thc Sfatc Contr�ctors Lew 18.27 RGW gnd <br />'l.�dl� ?00 wA C. <br />—� �'L�L� <br />MFNS([�OBbiAt� <br />FE�: <br />�5�r00 <br />�ERMITf� <br />_E15o�- Oy� <br />