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� -- - ------ - --- - -----� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> I <br /> 3`�3c� ��zuw�ou��y AvE <br /> PROJECT ADDRESS <br /> l,l UI���/1.�6� 3�i� ?��CtW�. �1/� 1=�..�'� \ ��� C�`a� � <br /> Owner Mail Address City Slate2ip Phone <br /> Tenant Mail Address Ciry State2ip Phonc <br /> �X Cle c�rQ.;c t v�c �l 1"l 1�3�d avE w ,_M l.i G�� 9'�L�{�j a�/��l�i�o <br /> ElecMcal Conlraclor Ma�t Address Ciry Sta�e2ip Phone <br /> Dc� ���� q �N7 a5o . � o <br /> Stale License Number Contract Pnce of Work <br /> -L����SSu 5�0.1r1C� �0.Y1 CAS�e, <br /> Proposed Use of Buildmg Contact Person (Plan Review) <br /> �� ��� <br /> Square Footage pf r idenlial new conslruction,remodel or addition) <br /> Number of devices(II low vc �age) <br /> Descnption of Work l0 13e Done: �Y�S�L�t I l�/ � �l VV ��Q�In��.��� 4�� <br /> 1 ` <br /> FEE <br /> CITY OF EVEItETT LOCAL SALES TAX CODE IS 3105 �D W <br /> I he26y ceRdy Uiaf 1 have read and exaniined fhis appGcation and know fhe sarne fo be 6ue and <br /> coRecL All provisions ol laws anU ordinances goveming lhis type ol work will 6e complefed <br /> wftMherspeci(ed herein ornoL The g�anling o/a pemrif does nof presume lo give authonty fo PERMfT# <br /> violate or cancel fhe pmvisions ol any olher sfate a local law mgulahng consfruchon nr fhe E I �� � _ I .�� <br /> peAomiance ol consfruclion. Tlrot 1 am authonzed Ly fhe owr�er o!fhis property fo perform fhe <br /> work lor which applicalion is made nd I comply with!he State Contraclors Law 78.27 RCW and <br /> 296.2pq WAC. <br /> /� <br /> a � <br /> Signa W re aIe <br /> eewaeo.vlara -- - ---- ------ --J <br />