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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMI'T SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa org <br /> �ISD U �03 � <br /> /f�',� `/�JrS7t' c�—�S—�S <br /> � PROJECT ADDRESS <br /> � <br /> OWf1er hlad Address City Stale/Lp Phone <br /> �.VG.C�iT G�I��� 5v1� 5 -��oo <br /> Tenant Mail Address Gry State/Zip Phone � <br /> %r��/h��a�lic�� �- �o.��.r'�9/y1r�-�rae, �� ��Z7� 3�j-�S-/�335 <br /> Electncal Contractor Mad Fddress C�ly Slale2 p Phonc <br /> 7�siiW312� ����/�'9 (?�3d 5�6 � <br /> State License Number(reqwred) G of Evzretl Business License Number(required) <br /> !/IT�tt. So4 ct� ��?G'D� <br /> Proposed Use ol wld�ng Contrad Pnce of Work <br /> S i�v� M �Z� r k�� <br /> Square Footage (If resider.hal new construc6on, remodel or atldit�on) Contact Person.�Contact NumbedEmad <br /> /D -Zo <br /> Number o(devices pf low voltage) <br /> Descriphon af Work to Be Done �L'/OC�ZZ. lE� ��.l�1�✓f_Z- SO�yi56�S, /��pK ��-� � <br /> --�— <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 l�i r�/l� <br /> -�1 ✓v <br /> 1 heieby certdy thaf I have read and exeminetl this applicahon and know fhe same to be Vue and <br /> coaect. All provisions o//aws an0 ordinances goveming this rype ol wo�ic wdl be completetl <br /> whefher specified herem or not. The granhng ol a permit does nof presume to give authonty fo PERMIT# <br /> v�oln(e or cancel!ho provisions ol any other stafe or local!aw regulatmg conswchnn or fhe r t �� J D, , 1 <br /> peAormance ol con5trucAon. Thaf/em authorrzed by the owner ol fhis properry fo perform fhe t I ✓� <br /> work lor which apphcation�s mnde and 1 compry�vi(h tho State Con7racfors Law fE'27 RCW and <br /> 296200 WAC <br /> � <br /> �/Yl�r` `f ' 7 ' (� <br /> '� Signa�ure- Dale <br /> nF',i.$=_C ae.Gcqn r� <br />