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� ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � �b �3 <br /> 425-257-6810 - FAX 425-257-8857 —www.everettwa.org <br /> G- Gv �3�8-OOZ <br /> �; 'D I Z eo-�,.r �2� . <br /> PROJECTADDRESS <br /> 20,� <br /> ��r� � L P�,.r r�S' �Se..,.� ,a< �o.�.\ E��'�7-,� ,,>�. 9fr o2 <br /> Owne� Mail Atldress� City Slate/Zip Phone <br /> Te00nl Mail Addrese Ctly StalelZip Phone <br /> sc � � sl <br /> W e STC� �le��-na� t-t-L G i 3 L 9 7�. �v�-`_ ,ri�rl-vs d�r-Le W a , f'� ��� �z.Dv <br /> Eleclrical Contractor Mail Address City State2p Phone <br /> oi <br /> a/J �Si c�L936 ki ��c�^ <br /> Slate License Number Conlract Price ot Work <br /> Proposed Use of Bwlding Conlact Person (Plan Review) <br /> �S�C� <br /> Square Footage pf residential new conslruction,remodel or addilion) <br /> INumber of devices Qf low voltage) <br /> I II <br /> IDescription ol Work to Be Done: l—D r/'��'r �'-�+..1 1"C.12'.—i 1 cT..,� lMRq � 70 �:� ��tl S�.-. <br /> I5,r,��a�-,�� , 8r�,�,. � Tv e.� a�, <br /> I T <br /> � ' <br /> I FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 ��vD <br /> � <br /> I heicby cchily fhaf I have rend nnd exnnrined fbis opplrca,.on und know fhe snme fo be tn�o end <br /> correcL All provisions o/laws ond ortlinancos govoming fhis typo ol work will Ge complefed <br /> whefher specified hcrein or noL The granling ol a pemiit docs nof presume fo give eufhonty fo PERMIT# <br /> violafe or cancel fhe provisions ol any ofher sfale or local law regulaling r.onstruclion or(he � �Ory� O QZ <br /> perlormance ol consfrucfion. Tbnf I am uulhonzed 6y fhe owner o/fbis property(o perfortn Ihe Z'j <br /> �vork lor which oppl�caBon is made and I camply wilh fhe Slofe Confracfors Law 18.27 RCW and <br /> 296200 WAC. <br /> g � � r � 3 <br /> &gnature Dale <br /> nFv�sen iemr� <br />