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---- -- <br /> � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 5 �.�:J•� �IZD�� wi� V E✓eiZ�� f� wlk cr�� �v ( � <br /> PROJECTADDRESS <br /> > <br /> �i l��ly uL�� ' �/ Cit Slate/Zip Phone <br /> Owner Mail Adtlress Y <br /> � <br /> G� '}- Z F'jv( G Stete2ip Phone <br /> Tenant MailAddress Ciry <br /> i � TIfLY'i'm/t /�"D"F`�l'�/'ll�" �l�' %a •�d/ �/ _cL�7��- �. /G <br /> � �/�i��°-C � � .Y���YN�I�Tl01� �(.0 � �k6�� UE Phone <br /> Eledrical Coniractor <br /> Mail Address Cdy State/Lp <br /> 5 L r!�'C f�l}S�j'd N�/ Con��Pr�e of Work <br /> State License Number <br /> Contact Person (Plan Review) <br /> Proposed Use of 8uilding <br /> Square Footage (�t residential new construc�ion, remodel or addition) <br /> Numter of devices Qt low voltage) <br /> � ., cv �r �C>Tr�i � 1� <br /> Description of Work lo Be Done: t� � �--�R <br /> I <br /> 'i <br /> � FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �.--7�,��/ <br /> 1 hereby certi(y that 1 have read and examined this application and know the same to be true and <br /> ✓ <br /> correct All provisions o(laws and oMinances c�oveming fhis fype olwork will be completed <br /> wtmtherspecilied herein ornoL The granling o/a permit does not pirsume lo give aufhonty to PERI �I I _ I /� <br /> vio/ateorcancelfheprvvisionsofanyothersfateorlocallawregulatingconsWcfionorUie � � <br /> peAomiance o/construcfion. Thaf 1 am autho�ized 6y the ownerol this property to perform the <br /> I �rork/or which application is mado and 1 compty with the Sfafe Contracfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �a ���/� ��c�-- l� l 9 ` I >' <br /> —�- Signature Dale <br /> I._ i�GVS[D3.':-'v'i3 - __--_-"___-_'-_ _- <br />