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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STR[E'f, EVERETT, WA 98201 <br />425-257 8810 - FAX 425-257-8857 — www.evereltwa.org <br />�� �e � �-r �U�,— <br />PROJECT ADDRESS <br />Tenant <br />l�v2r -��� <br />Mail Address <br />Mad �ddicss <br />�-17-/Y <br />C �yoU-/l� <br />�Y����_�V. �v�� �� — <br />c�iy si���iz�Pt`ZS 3rj�0�lil�Phonr. <br />Cily <br />Slate2�p <br />Phone <br />�i111$�1'L�� i(. 1351��4}-� olr S� Snoh�l'LSl� V�� q&aqlp yl5 Zlr� 55�i I <br />EledricalCoNraclor h1a�lAddress Cily Slate2ip Phone <br />Stale Licerise Numbero� <br />Propased Use of Bwldmg <br />Squ�re Foolaqe Q( residen�ial nr.w consirudion, remodel or addition) <br />Number o( devices (II low valtage) <br />Description o( Wark to [3e Dnne�. � I� 1� \� 1`� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />_ ��,UU <br />Canliact Piice of Woik <br />Confacl Person (Plan Revievi) <br />1 hom.by cerfily Ih��l I have rr.aJ ar.d exarnined Ihis app!icalion and Anov� Ihr. samc !o bc Iruc and <br />r.onecf. All provisions o/laws anJ ortlinancr.s governiru� tliis typc ol wod� r:dl ne cornplefr.d <br />w7rclher specdicd Nr.iein or nof. ihr, yr��nlinr� ol a perrnif does rrnt prnsunie fo yive aulhonty In <br />vio/ate o� cancel fhe provisions ol any o0ier sL�le or lor.al Inv� ieyuk�liny consl�ucfion nr O�r. <br />perlonnance o/ const�ur,lion. Ihaf 1�nn airtltorired by (hr, owner n/Ihis properly fo pe�lrnm fhr. <br />�voB lur which applicalron rs moJc and 1 complq �oRh fhc Slalc Conhaclnr.s 1 av� 18 27 RCV/nrril <br />296200 W�C. <br />i <br />_ � - -- -- - �-�- � �� �-- <br />� � itwe � Uale <br />FEE — -- -- <br />75 • � G' <br />� PERMIit1 -- -- - <br />I E- i �o �( l �8 — <br />