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� <br /> ELECTRIC�L PER�'�IIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8816 - FAX 425-257-8857—www.evereriwa.org <br /> q �3 �15 <br /> C-�sdi'-�u �( <br /> � v2 0? E✓s.e�o.�i=�/ uJ.%;' <br /> PROJECT ADDRESS <br /> �e.1 �P,�e �q�l���,0�..� �� r�� �o;a Na.�� wa, q$��a �53 3B� 3aa � <br /> Owne� Me�iNOdres; SlatelLp Phone <br /> W�� 1�Il.YJ W�V C/UI 1..f11�'`�� <br /> Tenanl Mail Addm:s City SlatelZip Phone <br /> O`�l T'�m F_ E l.F_cM�.� Fo Bo7� 3475�5' lJ9k���c� WA- 9 g`FS(o <br /> Electrical Contrador t.laii Adf.ess C�ry State�Z�p PFone <br /> Ou� -T-i/�y oa� L�3 �\�c� ��' <br /> State License Number(required) Ciry of Evere � Business License Number(required) <br /> �r'T�� S�i�s sp�-F � 13 BZB . yo I <br /> Proposetl Use o(Building Contrad Price of Work <br /> a�/�- �`�a��i< Kra l I a53 b7? - 3 g$9 <br /> Square Footage Qf residential new construdion, remodel or addition) Contact FersonlConlact NumbedEmail <br /> /U/!'r <br /> Number of devices(If low voltage) <br /> Descnption ot Work to Be Done T�y��`/T /s1PQ°�n���� ' fYl��i�Xi' ��`-'��--�5 f0��— Q�jQ�� <br /> �s��� , �4sh W�,o ; d�s/��'`"Z � /�����9t L.�.s�n�s �� <br /> ��v-�-, �-- .4���- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � �O�I , L.�� <br /> l <br /> I hereby certi(y fhat I have read and examined�hls applicafion and know Ihe same to be We and <br /> correct All provisions o(laws and oNinances goveming fhis type of wodr will be complefed <br /> �vhether speci(ed hereln or not The granfing o/a permil does not presume to give aulhonty fo PERMIT# <br /> violate or cance!Ihe provisions oJ any ofher sfate or local!aw regulating constiuclion or the � �^,r��� h�� <br /> perfonnance ol consfruc6on. Thaf 1 am aufhonzed by the owner o/fhis propeRy ro peRorm(he �U (/ <br /> work lor which application is m&de and I comply with!he StafQ Confractors Law 18.27 RCW and <br /> 296 20�C. ' <br /> � )�> /« <br /> � Signa re Date <br /> REVISED 06D6Q010 <br />