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�--- <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES / � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � — b � 3 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org G�306— ��' <br /> , � <br /> . �f�'� 7 h�'��,1 c�>�1� <br /> PROJECT ADDRrSS <br /> T ' � /�io )f3�-�«� � � � I�✓c LT c,�4 .,t/�-� <br /> �s�� t�2�c-�,'[Lc.�(�. <br /> Owner Mail Address Ciry Stale2ip Phone <br /> Tenant MailAddress Cily Slate/Zip Phone <br /> �, � 5 « , i Lc�,-,Z� G�c, �� 3Z 97'`—^ ,r'1i� ih4,w�>,�cc r,�� y8"�7v <br /> EleclricalCoNraClor MailAddress City Slate/Zip Phone <br /> �'< <br /> (nJC'S i% � �'�G lG/ S� <br /> Slate License Number Conhact Price o(Work <br /> Proposed Use o(Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction, remodel or addilion) <br /> Number of devices(If low voltage) <br /> � / 2 ;Ts �Z�� <br /> Description of Work to Be Done: l' �f L ' n � � /`C-�-��{Ge /� � G�"' <br /> FEE �� �O <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRily thaf 1 have read and exsmined this application and know the same fo bc true and <br /> correct All provisions of laws and ordinances goveming this type of work will be complefed <br /> whetherspeci�ed hercin ornoL The granting o/a pem�it does not prosume to give authonty to PERMIT# <br /> violate orcancel lhe prnvisions ol any otherstate orlocalla�v regulafing consfruction or the � � .�jG� _ O�� <br /> pedormance o/consWction. That f am autho�ized by Bie o�vner of this property fo pedonn the <br /> work(or which opplicafion is made and I comply wi(h fhe Stafo Contractors La�v 18.27 RCW and <br /> 296.200 WAC. <br /> ��_ ._% G -G� � -/ :� <br /> Signature Dale �,, <br /> rxevrseo:�.�a�i� <br />