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�, ii 2Qls 1��:53AN <br />�2c�.32i�4 F. i <br />ELECTRI�AL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SER�iICES <br />3200 CEDAR STREET, EVERETT, WA 9H2O1 <br />425-257-8810 - FAX 425•257-6857 — �vww everettwa.org <br />���� W'�11a�'P�r.� <br />PROJI'cC7 ADDRESS <br />OwnBr <br />Tananl <br />Electrical Contra:tor <br />titan adarocs <br />�l � .. _ _ <br />�� <br />n�all nddres, <br />_..�.� <br />tdail Addiess <br />C�s ��S H��� � � <br />Slalu License Number (ieQuirdC) <br />S1 �"� <br />?roposed Usc of �uileing <br />Square Foolage� d ntial new wnslruclion, remotlel or adaition) <br />O� <br />Number ot devices pt low vcltaBe) <br />Dsscuption at Work to Bo Uonc <br />�j��oati.�ls� <br />Clly <br />Cliy <br />C�ly <br />StatelZip <br />SlalcfLip <br />SiateZp <br />P�ane <br />Phone <br />Phpne <br />� I �D� <br />Giry ot [ve�ett Business License Number (required) <br />�,IUN�U� <br />ConUnet Price ot Work <br />�'A.I,��C1 R rnv4/� <br />Conlad PersoniCon act Number/E-maii <br />CITY OF EVERETT LOCAL SALES TA7( COOE IS 3105 <br />I huruAy Cwtify thal I navo roa0 and vxamined fhis app�icaGon antl know the snme 10 bc In�e and <br />cnrtect All provislons ol lews end orctfnen�es govem�ng this type of wo�k will be r.omplefed <br />wbelhci specified herein or nol The pranting ol a permit does not presome to givo aulhoriry to <br />violafe or cancol fhe U�ovisions of any otha s�alo or local la�v rogulating censhuqlon or Ihu <br />pe�formance ol cons6uclion Thaf I am authorrzed by the owncr af this propeRy �o pedomt fhe <br />wak for which anplica6on is mode and I comply �vifh the S�ele Con��ecfors Law 98 27 RCW and <br />296.200 LYAC. <br />R�SED OW6�01( <br />f�� <br />�D � <br />PERMiT# <br />� 15�1-�53 <br />