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- -- � -- � -- <br /> ELECTRICAL PERIV�IT APPLICATION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, �VERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org /� `� —�� <br /> L lUio-ozz <br /> � � � D ��✓-����� ��c� �C �D/c w� �r ��.� � � <br /> PROJECTADDRESS <br /> ��c..�f'c-� ��_ ' <br /> b U'Gv ' t� / �--�-9�I1 ,t�? �� <br /> OWnef Ma:IF,ddress � Gly State/Zip Phone <br /> j- y2�^ �Sy -35' 7 <br /> I � � t-�—e— ��_ <br /> Tenant MailAddress � �� ^ �ty � ��c,c, xv � Slate/Zipu�'`3_97oone, <br /> p. /-, �� �r � y <br /> � ,'h �� �— �/ P � 7�',� ,"� L � �, � wed�P �JJ�} 9 �u� 7 <br /> Elec�riCal Con�rac�or Mail Address ty State/Zip Phone <br /> �S //V�/z'/?1�/D f� 3 O � �'�� � <br /> Stale License Number (required) City of Everet usiness License N�r�er(required) <br /> �1)� ��C _ �/ir/�i S -� ' �� � <br /> Propose otDuilding Co�l��of ork S� � <br /> t�.�C- e <br /> / ,(� <br /> C� �=�� Siti�e,r' 2��ec�?ti� G . C� <br /> Square Footage Qf residentiai new construction,remodel or addition) Conlac�Parson/Contact Number/Email <br /> Number of devices (I11ow vollage) <br /> �7 �" 1 <br /> Description of Work to Be Done: /.1/1 $� l^�� C��1�7��L i��` // ( <br /> L� ld GLl �C l� � i� G+-,a^-. /� �. S' _ <br /> �'� l/` f. e �/I ln O, � C�^l.. � u . � TU U' G't �� � �� <br /> -' S a�.�J <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� 5O <br /> 1 he�et.y certily Ihat I have read and examined this applicafion and know the same t�be We and <br /> correcf. All provisions o/laws and ordinances 9oveming this fype o/work will be :ompleled <br /> :vhetherspeci�ed herein ornot. Tne g�anting o(a permit does not presume fo grve authonty to PERMIT# <br /> violate or cancel(he provisions o(any o(her stale orlecallaw regula(ing consWction or llre <br /> pedomlance olconsWcfion. Thaf I am authonzed by fhe o�vnerol this property fo pedonn fhe E l�{ [ 0- � ZZ <br /> work lcr which applicalion is made and 1 compty wi(h fhe S(ate Coniractors La�v 18.27 RCW and <br /> 296 29 AC. , <br /> // �� a � <br /> � � _.� :1-�. <br /> -�GSic na Wre Da ie <br /> REViSE00A�DS401J <br />