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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVi�ES <br />3200 CEDAR STREET, EV�RETT WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org !a � !� � / 3 <br />r_�� <br />`� /r/ ,D'�v ,�/w�. � <br />� , <br />PROJECT ADDRESS <br />/�'�Pr',>,S/,P/c�1 J,,d/✓�,1✓,� �.f1.�,�y 7U�' <br />Owner <br />Tenant <br />Mail Adtlress <br />Mail Address <br />City <br />Ciry <br />JS I.J t.�Wa <br />�13iz�.oa5 <br />d l��i-v i, � <br />=i.e✓v��4/� <br />� Phone <br />State/Zip <br />Phone <br />y��- <br />t <br />%�l o�i•S s� 'an� /.G- /r'� /.. c�:.. � ��� �%`I fir/,,,3/ -, r_, iii 9�.%> 3 3,P�-� � 3c <br />Electrical CoN�aclor Mail Address City Slate/Zip Phone <br />�,>Z u `/_—'/_-' Id 7 7.ri1 <br />Slate License Number <br />Srp�c.� -( <br />Proposed Use'o( Building <br />Square Footage Qf residenlial new construction, remodel or addition) <br />Number of eices (If low voltage) <br />�; v u <br />CoNract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: �'S � �� 4 _ _ /�'r /�%•-,�_ r �P�. � � � � ,� - 5 O/T .%= � f� <br />�x /�J � ,i /� �.J Jti C'.E i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereGy certify fha(1 have read and examined lhis application and know (he same (o be Irue and <br />conect. All provisrons o(laws and oNinances yovPming (his type ol work will be complefed <br />whether specified hemin or noL The granling of a permif does nol pmsume (o give aufhonty to <br />violafe or cancel fhe provisions o/any o(her s!ale orlccal law regulafing construc(ion orthe <br />performance olconstruc(ion. That 1 am aufhonzed by fbe ownerof this property (o peAorm Ihe <br />work lor which application is made and 1 comply with the Sfate Contracfors Law 1827 RCW and <br />29G.200 WAC. <br />� i��I --+�. <br />F[VISEDYIO/17 <br />/�-�/-/.� <br />FEE <br />� II�-� 0 <br />PERM17 # <br />E �3�a- oa5 <br />