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ELECTRICAL PERMIT APPLICATIOIV <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 />����.' �� �� - I� l�l�c? F1-�i � �A\C�tiL�,iZ� i� �- "_� � r� i? t it w�l <br />7 C-' <br />PROJECT ADDRESS <br />�� L� `;c-l�(!C'L �I�I <br />Owne� Mail Address <br />City <br />SlatelZip <br />�c-�s-r 3 <br />C i 30 5-og5 <br />Phone <br />�1G��ta���X �s�OZ 3a� ��a.� ��'� � v�etn ������ 4� Z�%I qz5 7_5� 3�7� <br />Tenan� Mail Address City StalelZip Phone <br />i(7- L=l= ZlZ �. (�Lf= G 1 Iz 7C: <br />Eleclrical Coniractor Mail Address Ciry StalelZip Phone <br />State License <br />I�A- � �r'� r�- �_ L <br />Proposed Use of Building <br />Square Footage (I( residential new construclion, remodel or addition) <br />Number o( devices Qf low voltage) <br />��� 5� <br />Contract Price of Work <br />11��z��� lti,'A LL� �wc'� <br />Contact Person (Plan Review) <br />�. � <br />Description o( Work lo Be Done: I� I� i��'� �-� �� ��`� t ��' `� ��' ��' �'' c� j �� �r� �.,5 r_1Z t 11 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hemby certi/y fhat I have read and examined (his applicafion and know the same to be fn�e and <br />corrrcL All provisions o(laws and o�dinances goveming this type a/trork will be completed <br />�vhether specilied herein ornoL Thc grantiny ol a pennit does not presume fo give aufhonty to <br />violate or cancel (he piovisions ol any ofhersfafe orlocal law regulating consfrucfion or fhe <br />perfor nance o/wnslniclion. That I am aidho�ized by the o�rnerof this propeRy to pedonn the <br />work r which applicalion is mad \ and I compty with the Slate Contrac(ors Law 18.27 RC W and <br />29G2 0 WAC. � <br />-r, ( <br />\,, �I l\. � �,`� '� I � �� I � � <br />�� �L � � <br />...___...._ Dale <br />Rec�sFr 3rzm�3 <br />FEE <br />� l�I-1_50 <br />� <br />PERMIT# <br />E �3o��bg5 <br />