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06;Od!�015 C3 30 <br />!GB?6 P 00^/CO2 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REE7, EVcRETT, WA 98201 <br />q25-257-8810 - FAX 42525)-6857 — wvwv.evereltwa.org <br />`-1 I �- I �-�� n � ��L �L, <br />PROJECT ADDRE55 <br />Ownef <br />Txnnnf <br />ElucUical ContrncWr <br />Mol Atld�oss <br />jS�II<<�C1:.�.3 <br />M.i1 Addrxss <br />.��c.� �Isr� � 2� _ <br />State Liconso Numbor (requin d) <br />�i� _ <br />Proposed Uao ol Bwlding <br />q�� <br />Squam Fooqgw Qf rnsidontial n w tonslniction, rnmn+lxl or aqddion) <br />Num6ur ol c'evices (If low vnllage) <br />Cdy <br />City <br />/ <br />Cily <br />�, <br />StnlnlTp <br />Slute21p <br />� <br />SL1tNZip <br />Phono <br />Phono <br />P�ono <br />�/� 3� <br />Cily of Evorott Business License NumDor (roquirotl) <br />/��l�l{l/�� /4si���� <br />CoN�nct Pnco af Worx <br />Contad PersonlCoulact NumbnrlEmoil <br />Doccnption ot Wo�k m tin Dono: �I�Ul/������� 4— <br />CITY OF EVERt fT LOCAL SALES 7/J( CODE IS �105 <br />—��T__ <br />�' <br />� <br />� <br />I hxrnby eerfdy Ihnt I lre�vo road nnd exnminotl fhis epplienUon ond knnw �bo semo fo bo inio and ✓ <br />corroct. A!1 piovlsions o/faws and orUinances goveminq thls typo o! work will bo complorod <br />w.�efher spedfied heroin or naL Thx 9rxnGng ol a px�md does nof prxsumo la prvx aufhorrry fo <br />wolatn or cancol (ho provisions o/ any oNor sfate oNocallaw rogulaGng conslrudion or fha <br />poMortnanco N tonxlnulion. Thnt 1 xm authomed by fAx ovmxr ollhls prnpuAy lo �wrinnn fIw <br />work lor wAich app pfion is mnAe and 1.mmply wiUr fh� S1afe Cnnfzdorsl.aw 18.27 HCW nnd <br />2�J6.200 W�C. /: <br />Y <br />Mn � <br />PERMITk <br />E I 50C� — OZ�] <br />