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f---� ----- <br />I -- <br />-- .. _ __�_—. <br />— � <br />ELECTRICAL'; PERMI�' APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 - warN.everettwa.org <br />E � 4bs- <br />� �ag � <br />2`l�fo 6�J� ►'11�ei��C \��c� ��:� <br />PROJECT ADDRESS ' ' <br />7 <br />Cwner h'aJ Address ���Y <br />C � i/i�- <br />Tenanl <br />I tC� <br />�o <br />�AaA AAtlress <br />�� E'ectm,:al Coniractor Ma�l Address <br />i � <br />� 6 <br />Ciry <br />_!-1_.'t""r <br />cr,y <br />i t. /N�T"EC�� ��-�t3ZLZ � — <br />� ,.�ate License Number � <br />� �eaN'� -1- U�k.11,no55 CA,��t✓ _— <br />I f'�oposed Usc ot Building <br />�� Square Foolaye (If residential new conslructicn, remodcl or 2ddiaun) <br />I 3_g � �I ; <br />j N�.imber of devices pf low votlayc) 'I ���' <br />, � <br />Uescnption of �flbrY, lo E3e Done: <br />(� S�u.11�-�,� <br />C <br />State.2ip <br />Slale/Zip Phone <br />ZOJ, <br />(A>�i `�`g��r 3s`r-2jpr <br />StatelZip Phone <br />� 2, 9Uo <br />Contract P ce of Work <br />Contact Person {Plan Review) <br />Phone � <br />� ' FE[ ---- <br />i /�/,/l��• <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 � G/1 =/ <br />! /V <br />I!rereby ceRdy that 1 have read and examined this app�icalioii and know the same to be Irue und _ ____ <br />��,�ct. Alf prov�sicns o//aws and ordinances govemin�7lhis type olwork wdl be complefed <br />�,.hether specd�ed herein or noL The grnntino o! a pem�it does not presume to grve aufhonry fo PERMIT# <br />vro�afe or cancel the provisions olany olhe� slafe or S c,il law ie9ulatir.g� n�sh�eti � or the r',/!'� +`I /� <br />pedo�mance ensfruction. Thaf ! am authnnzed b� INe o�ti�ner ol this ra eR b orlomi the C �•r(� kJ <br />�vork Ior �vh+c��pplrcafion �s rnada antl I compty w;lh tha� Stafa ConUacrors Lau� 78.27 RCW and _ <br />296 200 WA, � , <br />S-Z�-�`� <br />Dale <br />a � <br />_. __:L._ —.---_-_ � <br />