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i _ _ _ __ _ _ _ _ __ __ <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 a ��� _�y <br /> 425-257-8810 - PAX 425-257-8857 —wv��d.everettwa.org �`�b� <br /> &= ��� <br /> � Z �tic�c�c �� <br /> PROJECTADDRESS <br /> Ownet tdailAddmss City SlalelZip Phone <br /> Tenant MailAddress Ciry State/Zip Phone <br /> �_ 2c� aG <br /> /L�Qe�O�i/,'L 2�� u✓�L �o��,��i f;Y�YJ�.�_z��-9 � <br /> f ledrical CoMractor I�lail�ddress Cdy State/Lp Phone <br /> /�IIS �'LE /s' �j ���� <br /> Slale License Number nlract Frice of Work <br /> Proposed Us of Bu✓ ild g CoNact Person (Plan Rewew) <br /> Square Foolage QI residenlial new cons�ruclion, remodel or addilion) <br /> Number of devices (If iow voltage) <br /> Descriplion of Work lo Be Done ��,I ���C _�_���"�P—`--- <br /> FE[ - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �G�. � <br /> / <br /> I hereby certily that I have read and exan ined fhis applicalre^c��u know Ihe same fo he true and <br /> correcf. AH provrsions ollaws and ordinances gnveming fhis type ol work will be completed — <br /> whrlherspecdied herein ornoL Thr. grar,Gng o/a permif does nol presume lo give au(honfy to PERMITlt <br /> violafe o�canc^I(he prnvisions o/any olher sfa(e or/ocal law regulafing constn�cGon or fhe <br /> peiformance olconsfruclion. Thaf I am authonzed�y Ihe o�vnei o/(his propeiiy fo perform Ihe E I �(�p�% (� � <br /> work torwhich app6cafion is made and 1 comply wifh Ihe Sfafe Conhacfors Law 1817 RCW and <br /> 296.200 WAC. <br /> � - �c�2 2G'� <br /> �ig'nalure Dale <br /> rr asrn vxi u <br />