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02i0;i:014 18: 18 E�S 4:SJ5389Ji Ecer6l'een Securtt�- �J00: <br /> �' <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3�00 CEDAR STREET, EVERETT, WA 98201 <br /> �25-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> � �.(�" �� <br /> GI !/Oz..a3Z <br /> ��ID�L '��'DRCk <br /> PROJECT ADDRESS <br /> Nli 1 I 'T��.a'i C'.+-er,{-u1'l�l.Y� �� 31�Z �3Y���d�M u11�1-- q�?.c� � <br /> G`�vnCr Mall Addross Gity State2p P�one <br /> — C' ��e. — <br /> Tenant Moil Addroen Ciry Sta�c2ip Phone <br /> L•�fzs�3�(g-�so <br /> ��vfNUrt�rl �Gcti✓i-I�/,1 �l IS R,�'�a � l01 G—�.+�e� �� ��� <br /> [IeclricalCo tracta MoilA Gry Stata2lp Phonc <br /> �1��2GS�{ lal��. � 1 I , 12�, � � <br /> State Liconse Number ConVaci Price of Work <br /> I�LJ�`(�'���i3�.� ^" "". ` �t'' "..�" 1 <br /> Proposed Use ot BuildinB Contact Porson (Plan RevieW <br /> Square FOotege pf residenlial new conslructioq romodel ar adtlitlon) <br /> l - I <br /> Number otdevlws(If lowvollage) <br /> Descripllon o(Work to Bu Dane: (ivW Vl� I���}Q.. l.:_C� l� _�.sC�'�''�M 1 � �U�� � P�`�`�' <br /> J � <br /> �,c,PP�Y l C� Can��v�c� s -+� �. M.�vw�Y- . <br /> FEE <br /> Gfi'Y OF EVERETT LOCAL SALES TAX COUE IS 310G �f„ /„ �S <br /> 1[i Ili <br /> I hcrcby ccrtily thnf I hnve ryed and examined this app!!ca!!on end know�he samy(o be tiuo and <br /> correct. AIlprovi:rona o/Inws nnd ortlinances goveming fhis typc ol woAr w1U bc complchd <br /> whefherspeci6ed herein or noL The qrenf/nr�o)e pr.mri(does not presume lo give authoAry fo p�[ry <br /> viola(c or cenccl U�e provisions o(any othorstate orlocol fatvregulating constnrcfion orfhe � ' �O <br /> pedom�ancu ol constn�clion. 7hat I om auU�orized 6y tl�e ownor ol fhrs pmperty to peKorm Uie Z 7 <br /> work!or vihid�application is mada anU 1 comply wlfh the Stote Gonfracfors Lsw 78.27 RCW and � �� <br /> 296.200 WAC. <br /> � � alsl��( <br /> Signaturo Datc <br /> ncwscn»wo <br />