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— -�_ � <br /> ELECTRIf�AL PERMIT APPLfCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �Q � � /L/ <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org C�y��`D� <br /> � (� d ��� / / � ✓ vi r/l �t/'C � �C d" � w � s''%�rl��. ( C�G <br /> PROJECTADDRESS <br /> �W c.,Q���, � � <br /> ..� ,/- „� � ✓l_ � �P !�.Q '.��. �-a�1/1'�� <br /> Owner MailAtldress Gly Stale2ip Phone <br /> r `� y'ZS__ 7 S�- 3 � 7 ' <br /> -2 Gw� /= ve u e:ZT _ <br /> Tenant MailAdtlress City Statel2ip Phone <br /> / �s �- � 3 S-��� W yz s-�y � .-- <br /> ��. ��-P ..- �-( -r.��'^>I`L L y ��^v�n,p 1-+>� 98� � 9 7d� <br /> ElectPCalConirac�of �dailAddress Cdy StalelZip Phone <br /> .� �� � ���.T ��� � 3 � �`� � � � � <br /> Statt License Number(required) �— City of Everett Business License Number(required) <br /> / �.D Y> /(� / /C C /�(./�f S e - �J� Q Q" O <br /> Proposed Use of Bud ing ' Conl�ct Pri�(W�k S <br /> /i � y� .�. r S <br /> �..J / <br /> C/�etc � S.�hc�eo- e, / e���i� . <br /> Square Footage pf residential new construct�on, remodel or addition) Contact Pe:son/Contact NumbeqEmail eG i,..� <br /> Number of devices Qf low voltage) /� <br /> �7 !ZQ C�0�����r <br /> Description of Work to Be Done: _ � O�"` � ��v` /e x �/ <br /> �'�-. � ��-e--- � � e.✓-' �'�-/�7L <br /> � <br /> FEE r <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� _JO <br /> 1 here6y certil��Ihal I have mad and examined fhis application and know fhe same to be Irue and <br /> conect. �111 provisions o/laws and c,dinances goveming fhis type ol work will be completed <br /> �vhether specified herein ornoL The granting o/a pennit does not presume fo g�ve authonly to PERMIT# <br /> violate or cance!Ihe provisions oJ any ofher state or local law regulating constn�clion or the � I� I /^^ O�� <br /> perloimance ol consWction. Rrat 1 am aufhorized by fhe avnerol this properfy to perfonn the U <br /> work/or which applicalion is made and I compty with the S(afe Conlraclors La�v 18.27 RCW and <br /> 296200 WAC. <br /> ��/ � l� Z' � <br /> Signature Da1e � <br /> PEC�SE009'06�^.OIJ <br />