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— — — - -- - - - -- - --- i <br /> ' ELECTRICAL PERMIT APPLICATION �, <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ; <br /> 42S•257-8810 - FAX 425-257-8857 -www.everetiwa.org <br /> � <br /> 3ti�s l�rca�fw�. <br /> PROJECT ADDRESS <br /> i1�1�—��lJCs Q,1,-� � �d�'S6 ga�-HG�AJaNE Sca�lc_fWl} q�las � <br /> � Owrer 1,1ai1 Address C�ry SlaleiLp POone i <br /> �c(vt{� GroN�.� 3y�5 Br��t��w�tv iyVe���f�f- � W/� `/8.�03 �I <br /> Tenant rdad Aacress Gry S�ate!Lp f-non I <br /> (�'as� <br /> � (� �v� Sy�r..�s ��e n (f���ilrs�:v (�Q�Jer��1- W/+ 9��1�3 �i 6 �d s�I <br /> Elec�r�Con,ractor �dail Adc�ees Cay SlateiZ�p Pnone � <br /> l3E�('yssgssw� oaYfi�6 � <br /> � Stale License Number(requrced) Gty of Evcrett Business License Number(requlred) <br /> �t �oo, Ob I <br /> , Proposed Usc of Buddmg Conlrecl Pnce of Work <br /> i1Ll�c'- � G�ccbS <br /> Square Foolage(If res�denUal new construdron,remodel or add�tion) Conlact Persor/Conlact NumberlC-ma�l <br /> n�F�'(M�fS (a� bGfry S i9,asysl ems.c�, <br /> Numbc!ol devices Q(low voltage) I <br /> p ft� L �r p l 0 \ / W ti(� .Si C�✓11' i <br /> Uescn twn of Work lo Be Done: el �� �aJer '� <br /> � <br /> FEE I <br /> ' CITY OF EVERETT IOLAL SALES TAX CO�E IS 3105 y�OD� I <br /> 1 bereby ccrldy fhaf 1 have read and examined fhis appliwfion and know Ihe samo to be huc and J _ <br /> correcL All provision5 0l laws and ordinances governing fhis type ol work will be complefed <br /> whelher specified herein or noL The granfing o(a permit does nof presume fo�rve aulhonty(o PERMffJt <br /> violate or cancel 1ho provisions o�any olher state or local/aw regulafin�construclion or fhe ^ � D I J� <br /> performance ol conslruclion. Thaf I am autnorized by(he owner o/lhis property fo peAorm fhe C 15 5— V <br /> work for�vhich apphcation is mado and I comply wdh the Sfate Confracfors Law f8.27 RCW and <br /> zse.zoo wnc. <br /> ; :� s�r ��s <br /> ---- S�gnalure — -------- Daic - -------------- — .I <br /> iF�,�sc�[y^�:t�i: <br />