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ELECTRICAL PERMiT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />/�'OS S� � UF/ZE � �%7/jCL f.c)i'�-y <br />PROJECT ADDRESS <br />Owner <br />MailA00ress <br />Gry <br />Stale/Zip <br />Phone <br />(.�/�{1�7I}f2� 1�0.5' SF �v���' fi'1l�LL l,c)f�� ���e�7 � <br />Tenanl Mail Address Ciry Stalel2ip Phone <br />I l�L �� l� .J- N > - <br />Electrical Contractor <br />�3 t,�1 �si mq-�nl <br />Mail Atltlress <br />EG I �� f� lll- ��SGf-f- _ <br />Stale License Number <br />Cpinm��C%qC_ <br />Proposed Use of Building <br />Square Pootage pf residential new construction, remodel or atldition) <br />� � <br />Numher of devices (If tow voltage) <br />sr <br />Ciry <br />%�9-n�i �c_ CT <br />SlatelZip Phone <br />3a, s�: - <br />Contreci Price ofWork <br />lJSI� %/�L�DI <br />Contact Person (Plan Review) <br />(oG&- `�'S�/` /S�, � .r `��3 <br />Description o( Work to Be Done: �� �� Lr� � rG �V �/GE- /� � T� <br />r,��a�_ � �G, � <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />1 hereby ceRi/y fhaf I have rnad and examined lhis application and know Ihe same lo be frue and <br />conecL All pravisions ollaws and ordinances govemrng fhis type ol �vorlr will be complefed <br />whether specified herein or not. The granling ol a permif does nof presumc lo give aufhonfy !o <br />violale or cancel the provisions o/ any o(her sfafe or local law regulating consfniction or fhe <br />peAormance of consfruction. Thaf 1 am aulhorized by the owner ol fhis praperty to pe�/omr the <br />work Ior which applicafion is made and 1 comply with fhe Sta(e Confractors Law 18.27 RCW and <br />296.200 WAC. , / <br />L'J <br />aEaseo.vlau <br />FEE <br />50�ob <br />PERMIT# /Cl/ <br />E �`fo�-1-� <br />