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ELECTRIGAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[[T, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —wwvd.everellv✓a.org <br /> � ��r�iQ�-C�LP✓�' �✓�ve 7 7 <br /> P OJECTADDRESS � <br /> �c� �Lc� G��P l`6/� [3ru.��r� u��P ��/Pri77 `��, 377-Cz`�9� <br /> Owner MallAddress � City Slate/2'ip Fhone <br /> Tenan� LtaJAddress C�ty Slate/Lp Phone <br /> C��:,v,cr�ioil,k� �CPc1v; L <br /> G_�i�a�1��l�S`%c.�� P, o Z�'6 N�,-xh c..�.�� wo���O 9y�s� y��2y� �i� <br /> GlectricalCoMractor � b1a�lAddress C�ry Slate/2;p Phone <br /> L.B���cL.wJ.' / 9�5`1 �z� �� O O <br /> �tale License tJumber� nlrad Price o1 Work <br /> Propos_d Use ot Building Contact Person (Plan Revievi) <br /> Square Footage�If residenlial new consiruclion, remodel or addition) <br /> Number of devices(N iow voilage) <br /> �escription of Worh ta Be�one: �G(1�� d�iti✓./ N�iIP����Q'� �C n'7P� '� _ <br /> z�� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX COD[IS 5105 �F �O <br /> 1 hereby ceRiy lhat I have read andexamined fhis applicaUon and Hnor�Ihe same to be(rue and � <br /> ccrmct. AH provisions o//aws and ordinances goveming fhis typo ol tvork will Ge completed <br /> �rhefher specilied herein ornoL The granting o/a pemiif does notpmsume lo give aulhonty to pERMIT# � <br /> violafeorcancellheprovisionsolanyolhersfa(eorlocalla�vregul�tingconsWctionorfhe � I��\�' r�� <br /> peAormance o/cons/ructioa Thal I am aufhonzed by fhe o�anerol this property to perform Ihe ll I <br /> tvork lor which application is made and 1 compiy wit he S�ate Conlrec(ors La�v 18.?7 RCW and <br /> 296.200 WAC. <br /> /� � / � <br /> � : <br /> Sig ture Date� ' <br />