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� � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR SiREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �$ rS03 �YJ1(� <br /> 3 _ �s <br /> 1� �130 l�t�" �- �L iz — <br /> PROJECT ADDRESS <br /> S.�bwc.v.n l �R3v 1°l� �e S� �D Cl�x'�'f' ws�i �YL�b' <br /> �,ry State2�D Pnone <br /> Owner Mad t.aaress � <br /> i� �� �� l <br /> �\ <br /> Tenanl <br /> ;.tai aoaress Ciry State�zm ZS3 34b'�U�T�Pncne <br /> �v�-ec.�, �r.'�.- ZZu z(o (� � 4fir2 S � I C�n�- wr9- �I d'U 3 L <br /> Eiectr�cal Contractor t.taii�aciess <br /> Ciry St�te2 P Phcne <br /> �roT�� �S�'3s �3P 3� �fU3 <br /> State L�cen=_e Numher(requued; Ciry of Everett Busicess License Number(required) <br /> I�l`j -`ls <br /> P�S���'''�"�T — Contract Pnce o'Work <br /> � Proposed Use of Bmidmg <br /> ISquare Footag �I�idential new constmcuon, remodei or adddwn) Contact Person;Contact NumberlEmatl <br /> I � <br /> Number of dewces pf low voltage) <br /> Description of Wor1c to 6e Done <br /> �1��— '� lc�`�''`M " � Pu.�re�(, ► ��-1Y��1 <br /> w�n� 1 S� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 I �O� � <br /> I h.ereby certity(haf!have�ead and examined this applicahon anU kno�v the sarne to he true and _ <br /> co�ect. All provismns nllaws and o�dinances govemmg tNs type ol wark wrll be complefed <br /> �.vhefhcr sper.rfied herein or nof The grantin9 0�a pennif does not presume to g+ve authanty to PERh11Tr <br /> violate or cancel the provisions ol any o!her state or local law regiJahn,r construc6on orthe E ,� i 503- D�a <br /> pedormance of cons(ruction. Tbat I am aufhon:ed Gy fhe o�vne�o!this p�operty fo perlo�m(he <br /> work lor wh� application is rnade and I compty with the Stale ConVactors Law 78.27 RCW and <br /> 296 20 'AC �._-- <br /> 3 �t I ��f <br /> S aWre <br /> Uate <br /> AE'•6ErnsCi:���� — <br />