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_ � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �_.�_,3 <br /> 3200 C:EDAR STREET, EVERETT, WA 98201 <br /> 425-257-6810 - FAX 425-257-8857 —www.everettwa.org E�'�b'��7 <br /> � 3ifl �Aci�ic. �� <br /> PROJECT ADDRESS 'I <br /> �U-�'�`''A�— 3od D S l3 PAci��[. F'1l��'�Z't� 1M � �ZO <br /> Owner Mail Address City <br /> StatefZip Phone <br /> S A,� � �� A ���u�� <br /> Tenant Mail Addrees CAy <br /> Stete/2ip Phone <br /> �q� rlec� � lou U�lt���� 1'K Wd �l �Z�1�e�� 1�i� �8?�� <br /> Elecirical Contractor <br /> Mail Address Cdy late/Zip <br /> �-l�f' � C_ l� � P`�1� `� flao ,n� <br /> State Licence Number Coniract Price oi Work <br /> � n Contact Person (Plan Review) <br /> Proposed Us of Bui!ding <br /> Square Footage pf residentiai new construction, remode�or addition) <br /> Number of devices(If low voltage) <br /> �escription of Work lo Be Done: <br /> �� � A ca' S�J�-�� c � t��— EF��K� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � C � C� � <br /> 1 hereby certily fhat I have read and examined this appiication and know fhe same to be true and <br /> correc(. All provisions ol laws and ordinances goveming this type o/work will be completed <br /> whether specilied herein or noL The granting ol a permi(does not presunte to give autlionty to PERMIT# <br /> violate orcancel fhe provisions olany olher stafe orlocal law regulaling corsWction or the � � ,,, � � _ ' �.� <br /> peAormance ol construclion. That 1 am au(honzed by fhe owner ol fhis properiy fo perform the `� <br /> �vor}c lor�vl applicalion is mada and I com I wRh fhe Sfafe Confracfors Law 18.27 RCW and <br /> 296.2 A . <br /> � �� ' 2� � � <br /> igna+ur. Dale,^ �, <br /> �,c,�r n:+r�•�� --------- � ; <br />