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I --- - - -- — -- --- -- <br /> ELECTRICAL PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —�vww.everettv�a org <br /> ��w/3�g�S� <br /> t i <br /> ' ��-/ �� �-9 S�t-f v�s-r �✓ � �v�rc-r, r�t/fl q � �03 � – ` 3 <br /> PROJECT AUDRESS � y} I <br /> C E �i�r�R, /'66 97G Nf/+Pc�V�c�Fl �l���ga3� ���u�5-65� <br /> Owner L1aA Address Gty Stale' �p Phone <br /> ,�isFl `i� /t�� y�� `f ,��a�vr,�fI✓ �vS�cC n' Gvfa�bJo3 '`rzs3� <br /> 5 a -� I <br /> � Tenanl �� t.Sali Address Ciry Sta; �p Pncne �� <br /> � I <br /> Ow�v,'� E -�^ G�oP �o �7v i,v�R�'-- <br /> I -[ ,-}�i����{pr 1.1aJ�tldress Cdy State'Lp Phene I <br /> i <br /> i <br /> � � , .�.r Coniract Price of Work , <br /> S�rLi.� -1'l�y+,� � �S��Pr-t C � � �I <br /> Propo ed Use ol 8uddmg Conlact Ferson (Plan Review) I <br /> i/o 'f <br /> ISquare Foolage (If rosidential new construction, remodel or adtldion) <br /> �J <br /> Number of devices(Il low voltage) , <br /> , /�D� �rr�n�Cc' /�L'Lfi�� D � 5 (o�.nG� 1afJ ✓ 6���T <br /> Uescnption of Nork lo Be�one ; <br /> 6? �J O � �C f/�� _ I <br /> � <br /> - ---- -- - I <br /> FE[ I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �/r Q� <br /> C' <br /> I he�eby certilylhat 1 have�ead and eAamined this oppGcalron nnd knav the s�me fo be hue and _ i <br /> co��r nu��o��s�o��s oi ra�vs and ordmances govenung(hrs type of work�vdl br, corrrp/eted I <br /> �vhe7her specdied hemrn or noL The granhng o/a pemuf does nof presunm to give authcnty fo PERPITT'� <br /> v�olafe or canr,el(he prowsions ol nny ofher state a local Imv rogulahng construcliun or fhu �j /� I <br /> peAonnmice o/consWctiun. That I am aufhonzed Gy fhe m:ner ol this p�operty to pafonn Ihe E � � 7��(j �(�lJ,S <br /> �vork lor nhich applicafi�made and I coniply��✓d�i the Sfate Confracfor Law 18.271?CW and � <br /> 296.200 WAC� <br /> / � ,' <br /> � ������.�v�/ �'�9/a o � 3 _ <br /> Signature ;7i �Dale�� <br /> � rensl.0 y^,,.•, � <br />