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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRGET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - ww�v everetlwa org <br />%'"I � 7 P�Q,� /�..-� %�,� �t c��s 9��� 3 <br />PROJECT ADDRESS ( fZ���� yso3 <br />�� f Ce1,,, y� _«�,�j �..���Pffi wA-- 9�z� 3— <br />Owner ldail �ddress Ciry Sta!e2P Phone <br />Te^°nt h1a�iAddres� Gty State2�o Phone <br />�r'IL� t.o �..�.__— � �1N�� _ <br />Elechical Contraclor 1.tad Address Gty Slate2ip P�one <br />State License Number <br />Pwposed Use of Buiiding <br />��o � 2 <br />Squaie Foota9e p( resiAenhal new consiruction, rernodel or addition) <br />Number of tlevices (If lo�v vollage) <br />Contract Price of Work <br />Contact Person (Plai Revie <br />Descnption of'Nork to Be Done� 1 r9��_ f/u e ?�Py'i�i%� �__ ____ <br />_ - <br />- <br />-7'' ����� /�-� t� <br />./-/L��G_:L—�'1-�' w��C�t //-,���%r.ul_)._�L��lcL�-:Snt+ /1 r�n{ G _C! �G L< � +5 . <br />// <br />%�j-�re---p-�i�..�a1-1�1t',�!/��.�rz•�{ -__ ----- - <br />/ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I herchy cer6ly Ihaf 1 have reaJ arrd evarruneA (Ins application and kno�v (he same fo 6e (nie anti <br />conecL All provisions ol laws and or9inanres govenung (his fype ol work will be complefed <br />�vhefher specihed he�em or nof 7he gr�nfmg o/ a pemvt does nof presume fo give aufhonty to <br />v�olafe or cancel t/re provisions ol any olne� slafe or local la�v �eyul�hng consln�ction ar fhe <br />pe�lorrnance ol conslrucGon Thaf I am authonzed by fhe owner oI fhis properiy fo peAomi (he <br />�roM lor �vlrich aI�P��ca(ion is maUe and I cornpry v,rlh (he Sfate Confrac(ors Law 78.27 RCW and <br />?96.200 WAC <br />� <br />�'�-/ -3 <br />RC V�SL-0 NO�i ] <br />FEE: <br />%� <br />I v <br />G� <br />PERMIT# <br />E �3�q-- b73 <br />