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� - �- -- -, <br /> �- I <br /> ELECTRICAL PERMIT APPLICATION <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 /> ��� ��s � �� �� G� C1�7 D/7 <br /> PROJECT ADDRESS � <br /> i�Pi �'/ �j ' h �l`5 <br /> i <br /> O�vncr Mad Address Ciry State2p Phone <br /> Tenant M.il AdAress City Stalel7ip Phone <br /> c � �1��. �� � �so ��� ��w, s� h w�� ���z <br /> Flectrical Conlraclor Mail Address C�ry State2�p I�nonc <br /> C��-� L�a� y�,�9 �3 �68� <br /> Sta�e License Numbcr(required) Cily of Everett Husiq�ss I_icense Number(requireA) <br /> a <br /> R�s , -��� - <br /> Pruposed Usc of�uildmg . Contract Pricc of Work <br /> Squaie FoO� (If residenlial new construction, remodel or addition) Contacl PersonlConlact Numbe. �mad <br /> Number of devices(II low voltaye) <br /> Desr,riplion of Work �o�e Done� _��r P�� �-- - <br /> FEL — —— <br /> CITY OF EV[RETT LOCAL SALES TAX COOE IS 3105 �0 �� <br /> I herchy r,crlily fhaf I have m.ad and exnminr.d Ilris applica6on and Ivrow Ihc surnc lo Lc huc:md ----_ _---._._- <br /> conn,cl /lll provi5ion5 ollmv5 and oNinances yoverning Ihis type ol ia-ork wAI br. cornplefed --- � -- -- �- <br /> whethr�r spr.r:died herein o�nof. T hc gran(in�ol a pennR dncs nof presumc[o yrve�authonfy to PERMITt7 � <br /> vioLVc o�r�.��r,!the provisions o/any olher s afe or local law regulatin9 consfn�r,fion or Ihe � 1 <br /> pr.rfon anf cc d r.onshuction. 7haf I am� d �rized hy(hc o�vnerol fhis pmperty fo perfonn Ihc E �D f —a�� <br /> wor oi�vhir.h appGcalion�s made anr c n ply�vdl�fhe Slnte Confrar.(or.:I aw 18 27 RCW and —_---- —_ _--- <br /> 29 ZOO WAC <br /> / — — - /� ��/�jJ�� <br /> � Signalu ` � �atc J <br /> iarvr.i�o nemenn i e <br />