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� <br />� ELECTRICAL �ERMIT APPLICATION <br />CITY OF EVERr-.TT PERMIT SERVIC�S <br />3200 CEDhR STF,E[T. EV[RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www evereflwa org I`/.3 v�� <br />�l So �-0(7� <br />_ � 5��3 0? ^-� S+ .�� � C <br />PROJECTADDRE55 <br />1�1K.�'r�g_r�rs �l ati ��lls .� s� 511or a �yle�W���o6� �Yas)SR8 a°>,3 <br />Q�y�¢� t,'.i i A�Are;s CqV Stalu'Z�p P�onc <br />' PQsful.�lQneu _ ��I`f 13�7nA ��.5�`�C rUC►�e.h,W_/1_Y�.�oP �y���Ss�-asao <br />TC^3^�' I.:a��l�QRN.; C�ry tilalr�2ip PnOrC <br />S; <br />� !'ech <br />Idail �tld�c,s <br />uEiz�y/uGt�sSL3 <br />Stale L�cense Num er (reqwre.d) <br />N�aposed Use o' Bu�lAing <br />� Sq�are Foo�age (II residenlial rew construc,inn, remoAel or atla t��on� <br />� <br />N�mber ol dev�ces Qf iow vollagel <br />Gty <br />W � �.��3 (�j.�s) �3� 883s <br />Statc�L�o Phn�e I <br />- � �ZY��6 ' <br />Cdy ol Everc;t Business L�cense Number pequved) �, <br />�vo °� _ � <br />CUnIraU PnCu o� WOrk <br />g�R � J �i Cc 61' <br />Co^.tact Pcrso^�Co�tad Number/Email � I <br />� e� P e�M; Is�b¢/r y r�� n s�,�f antr. c.,., <br />I)u5u�p6on oI Work to 6e Dn^e � OU F� (�(Q nO U p( -� _� W/I�S�iL----. —. <br />r—r— <br />� CITV OF EVERETT LOCAL SALES TA% COOE IS J105 <br />� I hereby crrlJy fhal I have rr,�Aand e+arnmeel fhrs app6calion end know the same fo be hue and <br />, roner.f All provis�ons ol laws anA ordinances 9ovcrnm9 Ihis type ol work wdl Ge cornnlcleA <br />. whelhe� specdieAhr.rein or nof Thr qaiNing ol a perrnit does nof preswne fo grve aulhonty lo <br />I wolalC Ur r:ancel Ltie provis�ons ol any olher slafe or loCal iaw regufalmg conShucGon or Ihe <br />'� prAorniance ol tonsHuchon 7ha! I am .lu(honSeAby Ihe owner q/lh�5 prop vty lo perlprm Ure <br />� wo�M for �Nnch apP�������on �s madc and I comply wdh Ilre Sfafe Conlracfo�s Law td 27 RCW BnJ <br />. 7g6 200 WAC <br />I -�'�"�.�j— _ l � - ------ <br />�� S�yn.IIJiC , , D.11�e <br />U <br />FEE <br />�0�6— <br />PERt•tiia <br />E 150(-D(oZ <br />� <br />