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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STR[GT, EVERETT, VVA 98201 5'. �.D—I�/ <br /> 425-257-8870 - FAX 425-257-8857 –www.everettwa.org <br /> C 1 40S �" � �� <br /> 2�f U2_ 2�c�c�,/ (���� 1� <br /> PROJECT ADDRESS <br /> J��2rr�_ -� <br /> � 2-'fuv i�%���� � � Wt3—����vl Z°(� �l�_Z1i'�n� <br /> IOtvner hiadAdtlress C�ry Slate/Lp Phonc <br /> I <br /> Tenant 1.9ad Address C�;y Slate/Lp Pncne <br /> I �� <br /> : � �� • ' r�. �d /3�D _� � „�-' ,"o �'A �G Z� 1//na,�.�55�h1�U�_ <br /> cletiricalConiraclor 1.7aJAddress Cay State7Lp Pnone <br /> /L R�IEI-F G���7l>J f ---� ^ `� � <br /> Slale LiCense Numbir CorJrar Fn[e o1 Work <br /> � /�%���i��ir� <br /> Proposed Use of Buildmg �-��— Contact Person (P�an RevievQ <br /> /J/� <br /> Syuare Pootaye Qf msidenlia ne�v construclicn,remodel or addition) <br /> Number of device�J(II lor+vollage) <br /> Dascifption ot Work �o Be Done: �i - LS !« � F-+-e.-�l.�{q�t_`��_ �l ir1��_7CY��-�/"c����.� <br /> _ `� �� �U'oJ n� ��n_����1��!'/iy.1S1�k.CL1�'�`�1��-f ------- <br /> � / <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 l 3� •C�� <br /> 1 hcreGy cerfrly fhat I h�vc read and e.ramined fhis applicotion and kno�v lhc same(o Gc Inic and <br /> correcf. All provisions ollaws and oNinances goveming fhis type ol�roik�•.ill Ge comple(ed <br /> v�hefher specdied hcrcin or noL Thc giantiny ol a pe�md does nM presume to give aulYonty lo PERPIIT;, <br /> viola(eorcanr.ellheprovisionsolanyolhers(a(eorlocallaw�egulafingconshuc�ienorthe � ' ��� <br /> pedonnance oltonslmc7ion. Tha(I am aulherized by(he o�vner o/(his propedylo perform(he ,� , I �� <br /> �vork!or which applicalion is made and f comply ualh Ihe S(ate Con(raclurs La�v 18.27 RCW and <br /> 296.200 Wi1C. <br /> ��'� l/�}/�'� � C��.�1-� S �30-/�� <br /> — Si9nature��- Dale <br />