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ELECTRICAL PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT BERVICES <br /> 3200 CEDAR STRE[T, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -w�^nv.everethva.org <br /> 3331 geoA�uay <br /> PROJECT AODRESS <br /> Ov:ne� P,1ailAddress City Slate2ip Phone <br /> Ftor�worLicS 3331 g,z�a�w�y �VF_2�T'i' �.�A 9�� 1 <br /> Tenant MailAddress Cily SlalelZip Phone <br /> � S�-lcnv-� G�E3� �nrG. �dvo3 5rv�rrH Avr �vSeErr W� S`�Zc�) '-)zs'3i� gzr� <br /> [IeclricalCoNraclor h7adAddress Cily SlatelZip Phone <br /> I �'�O � <br /> IS�Ae.ne.29�lNDO -- -- — <br /> Slate License Nurnber Con!rad Price of Work <br /> I Contact Person Plan Review) <br /> Proposed Use of Bui;ding ( <br /> Square Footage(If residenlial ne�v construction, �emodel or addition) <br /> l_.—_ � <br /> Number ol devices(Il low vollage) <br /> — <br /> r _ _ _ _ _ <br /> Qescription of Work to �e Dona ��2� AfAK>^'� TENAN� IM(�2[,v tM�N�' r__ _ � <br /> ____ . —_.,_._ _ . . —. _..--i <br /> FEE <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS�105 � g 2�O <br /> 1 hereby certily fhat f have read and e.ramined this applicafion and kno�v fhe same lo be frue and <br /> cwrect. �lll provisions o/laws and ordinances goveming this rypo ol vork vnll Ge complefed <br /> whefherspeci(ied he�ein ornot Thc granfing o/a pemiif does not presumc(o givc auN�orify fo PERMIT� <br /> vrolate orcancel Nie provisions ol any othersfafe orlocallaro regulating conslruclion orO�e r I�O r _ + /_� <br /> peAormance olconsWcfion. That I am aufhonzed by Ihe o�vner ollhis property foperform fhe C lQ � ll� <br /> u�o�k/er�vhich applicafion is made and 1 comply�vilh fhe S(afe Contracfors La�v 18.27 RC W and <br /> 296.200 WAC. <br /> ___%�� —� �l�s�'y <br /> 'Signa urc Dalc <br />