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Aor. i6. 2U15 1U: 22Ah� �o. 9054 P. � <br /> t <br /> E�ECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, WA 98201 <br /> • 425-257-8810 - FAX425-257-8857—www.everettwa.org � `� _�� <br /> �iSoU —i7z <br /> u�►11 5�,� c;� <br /> PROJECT ADDRESS <br /> _�+^is �f'�-v'dyllo u�ll ��i.J :�.1,'ex��. w�-��2v� ua�-���-�sz <br /> Owner Mail Addrr.ss Cily State2lD Phone <br /> Tenanl Mnil Atldress Cily SIale2ip Phone <br /> ��� KO_ L�'1� �(U� i��Q �a,�,4 n[_ l.(7 �—Z i 7� �-(`1U� <br /> EIBG�calCont2Ctor MailAddress Ciy State?Jp Ahono <br /> �S F-t�f,Sti��R-1�_ l�L�loB� <br /> Stale License Num6er{required) Ctty of Everett Business License Number(;equired) <br /> �.as�c�tiuR <br /> F'roposed Use of Buildlnd Conlract Pnce of Work <br /> Square Footage(I(residential new construction,remodel or add'Aion) Conlad Person/Contad NumberrEmail <br /> r <br /> Numbcr ol devices(If tow voltage) <br /> Descnplion of Work t��Be Done: ��� I �n, {�-f �inl. ,�]((CJ�� <br /> FEE <br /> qTY OF EV[R[TT LOCAL SALES';AX CODE IS 3105 ��QC� <br /> I Leroby ceilily fDat f have iead and axamineJ this vpplicnlion and know the same fo be huo and <br /> currec�. A/l pmvrsions n!faws and ordlnnnces,qoveminp(his type o/work will6e comploteJ <br /> whatbe�specilicd he�ein nr not 'Rie grantinp ol a permd doos not prosomo to give aulhority to PERMCI�# <br /> v�olafc or cancol fhe provisions o/any other sfalo or laallaw rogulating consbuclion or Ihe <br /> performanco of construdion. 7hot I om nu(hnr'rzed by lhe owne�ol this propeity fo peAom�tho E I �/��_ (�� <br /> woAr lo�whicb opplicotion is mece and 1 comply witlr fhe Stafe Conlrac(ors Law 18.27 RC W and v < < <br /> 296200W C <br /> ��� �'ZSf '�� <br /> S�gnglum Dalc <br /> REV15E0olonaou <br />