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� � <br /> ELEC�'RICAL <br /> PERMIT APPLICATION� <br /> I CITY OF E4'ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> �3� a3-�5" <br /> � E� so,3- � ib' <br /> I <br /> i <br /> I SZoi bv�wc,at�+J �Ay <br /> PROJECT ADDRESS <br /> A1A T v 'Lq � y��A'i CN�2o+�RA tS�L. — <br /> Ovmer tdail AOdre55 Gty SIatNZip Phone <br /> �JA'f'v2At wny C�ai2a4rrH�Tic. -�zcl tvt2�.'2t6.V �JAM �v4Ra9'� Wf1 9k2o3 <br /> Tenant �dadAdaress Cdy State/Lp Phone <br /> I SEr-��ur, CJj3L1N4 1�i2 kv:rt��7 Rv� STE �zo Evu2tirr wA 5`G2�� 'izti s�� 'az5y <br /> ElectnC21 Conlractor trail Address Cily State/Zip Pnone <br /> s,���.s.�y4o� oS3�O,�'"s <br /> State License Number(reqwred) Crty ot Everett Business License Number(requued) <br /> i (�S UC� <br /> Proposetl Use oF Bwitling Contracl Price of Work <br /> ��,=r• 3�sswco NzS z53 sG9y <br /> Squam Footage (If residznlial new construction, remotlel or addition) Contact PersonlContact Ncmber�[mad <br /> Number of devices(If low voltage) <br /> i <br /> I Descnption of Work lo Be Done. �'�2� q C-A2in "T4=ni�� 1 h^Przuvc"'�t1�3 1 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 � N � �O <br /> I 1 <br /> 1 he�eby cerldy fhaf 1 hnve read and examined fhis apphca�ion and know fhe same lo be true and <br /> correct Atl provrsions ollaws and ordinances governing this type ol�vork�vdl be completed <br /> whefhe�specdied hc�e�n ornoL The grantmg o/a permd does not presume to g�ve authonty to pERrv11T# <br /> violate or cancel the provisions ol any olher sfate or local law regulating conslrucfion or Ihe r ���� ^ I ( � <br /> peAomiance ol consVuclioa That I am aufhorized by fhe owner o!fhis property fo pedorm Ihe C <br /> work lor�vhrch apphcahon�s made and f com�;y�wfh the Slate Conlraclors Law 18 27 RCW and <br /> 296 200 WAC. <br /> �� �� 3J231i�" <br /> 5 gnaWre Dale <br /> RE�ISEOOBA6?O�a <br />