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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 /> �lo � �L'1l� D�.�v� <br /> PROJECT ADORESS <br /> ToNK CR.oa�N <br /> Ownet MaAAddrese Cdy SbtelZip Phono <br /> Tenanl MailAddrese City Slate/Zip Phone <br /> ��i.��K«- ylla 1t7� S�N►� �r�,umD w,� 98a9z y�-a9s-�e / <br /> EleclricalConiractor MailAddress Cily SlalelZip Phoae <br /> � �D6� F T9�6c.3 <br /> Slale Lfcense Number Conlracl Price ol'JVork <br /> �S �n <br /> Propose se of Building Conlact Person (Plan Review) <br /> 1700 1� -� G� �-�� <br /> Square Footage (I(resid nlial new construclion,remodel or addition) <br /> _ .� <br /> Number ol de�ices(If low voltage) <br /> Description ol Work to Be Done: V" � �"`� 77LU" £�� �JG�� <br /> FEE � <br /> CI7Y OF EVERETT LOCAL SALES TAX CODH IS 7105 �O � <br /> 1 heroby ceAily fhat 1 have mod and exemined flils applicalion and know Ihe samo fo bo frue nnd <br /> correcf. All provisions o/laws and ordinances goveming fhis fypa ol work will6o complofed <br /> whefherspecilicd herein ornof. rhe granling ol a permit does not prasumo to give aufhonty to PERMCf# <br /> violafe or cance/fhe provisions ol any ofher slale or local law iegulnting cons(ruclion oi(he � I' t O�_ O� I <br /> perlomianco o!conslnicfion. Thaf 1 am nulhonzed by tho owner o/fhis property fo peAorm fhe �� <br /> woik lor which pplication is mudo and 1 comply wifh Ihe S�afe Confraclors Law 19.27 RCV/and <br /> 296 200 WAC. <br /> ���! <br /> Sig ure Oate <br /> REYISFDY70'l] <br />