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� <br /> , EL�CTRICAL PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> j 425-257-8B10 - FAX 425-257-8857 —www everettwa org <br /> I� 3 —�-b —i3 <br /> C �30 � —16� <br /> � � ZD2 �o�i3y �-�t <br /> j PROJECTADDRESS <br /> �I Ovmer Ma�lAtldcess Cny StalclLp Phone <br /> I PERFo�-nn r�NCL �1c�E N��fl��R� h� f1-�o� � <br /> � Tenant Idaa Address Cdy SlatelLp Phone <br /> ' b Ri»��1(a ���.�-2�L by - i�&+�, P� Sw ��N�v�,.�o07 c�� 4'P�B� <br /> �� [IecincalConiraclor lda��lAddress Gty State2!p Phene <br /> ' ��? � Dl�E ,� blo -� R7 $ 22aO . 0U — <br /> State License Number Contract Price of Work <br /> � CJ wc wt�e.c i��— � <br /> �� Pioposed Use ol Bwiding Cantact Persan (Plan Revie�v) <br /> ISquare Footage pf residential new consiruction, remodel or addrtion) <br /> Number e1 dev�ces Qf low voltage) <br /> Descriplion of Work to De Done: L� �� � ��� S`"� � �U r 1 T <br /> � <br /> � <br /> � <br /> i -- <br /> FEE -- <br /> CITY OF EVERETi LOCAL SALES TAX COD[IS 3105 I Ox SC� <br /> � V <br /> 1 hereby certdy thaf 1 have read and exarnmed fhis applicafion and kno�v Ihe same b be We arrd <br /> correcl All prov�sions of la�vs and ordinances 9oveming this type ol work�vill be completed <br /> �rhether spealied herein ornoL The granling o/a pemuf does not presume lo grve authonry fo PERMCfit <br /> vmlate or cancel the pmvisions olany other s(ate orlocal la�v mgulating consfrucfion orthe E � 3 03- I (o�S <br /> pedoimanc o/ . crion. Thaf I am aurhonzed by Ihe o�vnero��his p�ope�ly lo perfonn the <br /> �rork lor w � app6 ahon i ade and!comply a�dh Ihe Sfafe Confractors Law 78 27 RCW and <br /> 296 200 �AC. <br /> d3 _ 2 � - Z� I <br /> Signal e Date <br /> re�,.,..-�. ,�:,i.� — _'-- <br />