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ELECTk��AL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[TT, WA 98201 3 � �O- � � <br /> 425-257-8810 - FAX425-257-8857 -www.everetlwa.org C )({03...�'a/ <br /> 1�J <br /> 3/�:� /v���_� , �',��c���� J���.�rc�f or,� <br /> PROJECTADDRESS / <br /> L �l�� <br /> /�,/jr��_��,�, 3��=���� f��r�-��g�,�� ����� <br /> Owner Mail Address Cdy � Slalc2ip Phone <br /> TCnan� A1ail Address City SlalelZip Phone <br /> �l1�eM � � �t��l3j�'��'���'��"��'�d3�f�BG�O ll1 G��.�u/��t$�l.� ��173�� <br /> Eleciriwl Conlract Ma�l Address Gry Slale2ip Phone <br /> l�fGu�i i�` �I��l� ���� <br /> State License Number CoNract Price oi Work <br /> G���� �.�n�� <br /> Proposed Use of Ouildina Contact Person (Plan Review) <br /> ,2 S�l,�` - <br /> Square Foolage (If resider.lial new construclion, remodel or addi�ion) <br /> Number o(devices (If low vollage) <br /> eA/7' i /� / i <br /> Description ol Work lo De Done: /(/�G1ir��j Gll��f/� �✓/� ��< /� ���Lsi� �� <br /> Cil�_�� �i/�G� , �i �d� �D✓�Di4 /'1.rG/�1�����j`"1Q <br /> ��� . ��,�,�, yU,���,���.,,� �d .����, �,�����,,� <br /> i1�'�/.zU/I rcu�,cd�,%�, G�� f �l� �'ar v�ll-�,,cu�F.u�',�' <br /> FE[ <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 //� �j <br /> 1 hc�chy certily tftaf I havc read and examined llris applicalion and know the same fo be lruc and <br /> correcf. All provisions ollaws and orUinances governing Ihis fype of work will be r,onrplefed <br /> whc(her speci�ed hemin or noL The,qranting ol a pemiil does not presume(o give a�dhonty lo PERMTT# <br /> violote orcanccl the provisions o!�ny ofhersln(e orlocal law regulafing cons6ucfion or Ihe � I ,/��_� -, / <br /> pr.ilomionce o/conslniction. Thnf I�im authonzed by fhe owner ol ihis pmperfy fo perlorm fhe �-'" lit�� <br /> work lor which applrcation is made and I comply wifh!he S(afe Con(ractors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> �-- 3. �,�� <br /> Sign5lure Dale <br /> IR VC,H)i?Np <br />