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ELECT•CAL PERMIT APP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVCRETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br />s'6 0 �' s�n s�� / �� <br />PROJECT ADDRESS <br />Otvner <br />Tenant <br />Mad �dtlress <br />Mail Ilddress <br />EledricalContractor MailAtldress <br />�I�D /' C o � 9�' /75 B� <br />State License Nurnber (required) <br />/�e 5 <br />Proposed Use of Building <br />C�ct IM � <br />City <br />City <br />�s���.�� <br />Square Foolac�e (If residential new conslruclion, remotlel or addilion) <br />Number of devices (If low voltagc) <br />DescripGon ol Work to De Donc: <br />CITY OF [VERETT LOCAL SnLES TAX CODE IS J105 <br />Qty <br />� <br />6 ._.o� ��s <br />E rs�6-ou7 <br />SlatclZip <br />State/dp <br />�. <br />Slatcl7_�p <br />Phone <br />Phone <br />�06 <br />Pnone <br />�� . � s' _ 9P.� <br />Gty ol Evere�� �usiness License Number (requued) <br />��j,� oG <br />Conlract Pnce of Work U��^ u3� _ p�f7 � <br />��2r'�Yj �//7P,r (fC S / <br />C'� �� `�. .?a �- 7/Y - Yy<'9 <br />Conta:t Pcrson/Comact NumbedEmail <br />I hcieby cerh/y lha( I Imve rc�d and cxamined Ihis �pplicalion and know �hc same fo be 7nie and <br />correcf All pr�visions ol la�vs m�d ortlinanees governing fhis type ol work �vdl be cornplefed <br />whc(hcr specdicd herein o� noL The grt�nhng ol a pennil does nof presumc (o yivc aulhonty lo <br />violafc or canccl Um provisions ol any olhw sla(c or lor,nl lnw rogula(ing consfniclron or Ihe <br />peAormancr, of consfruclion Ihat I am aulhonzed by Ihe owner o/lhis property lo perlomi fhr. <br />wak lor wluch applicalion is madc and I comply wifh fhc Sla(a Conliacfors Law 78.27 RCW and <br />296 200 WA� � <br />/ <br />�' �j i /� ��'% <br />__i'�1�' ..L_ � ---- - -- ---L•-���L--y----_. _ <br />ignaNrc G� Daie / <br />ucvrsrn oamr.vou <br />�f �r��z% _ <br />��'--�-<- u ; � <br />FEE <br />� �0 Do <br />PERMITA- — <br />E I 5U� - ��i� J <br />