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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320G CEDAR STREET, EVERETT, WA 98201 / ;�-I 3 - �j <br /> 425-257-8810 - FAX 425-257-8857 -www everettwa org I <br /> � � '� i z _ogu <br /> ' �� � Q �'�k9� �c� �4-� <br /> PROJECT ADDRESS <br /> (�y NT�l�✓�- 2�4«Lr,�/ �V{.���T /,v���/ S2s� - <br /> IOwnCf Mad Adtlress Cily State2ip Phone <br /> � � <br /> �-- <br /> TenaM Ma�l Address Cay Slele2�o Phone <br /> '��� �,qn ,A �C€cTe�C ��3 So�/ s�C'£� ,G�iiuG'r�� 33 <br /> Electrical CoNraclor Wad Atldress C�ly SIa�e2ip Phooe <br /> �O <br /> �H£��- r-���v��/ � � �S`_ <br /> Stale License Number Contracl Price ol Work � <br /> ��s� �:,tIC.� <br /> j Pmposed Use o(Bwlding Contact Person (Plan Review) <br /> ���� <br /> Square footage(II residential new conslruction,iemodel or addiGon) I <br /> � <br /> Number of devices (If low voltage) ' <br /> Descnption of Work to�e Done� I�'1�� G� +�'v � �� ,�,e ��.�(l.�/�4,Sf�ae . . � <br /> �( <br /> ��.����..�_ ��s�os� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 �`� ' <br /> I hereby certdy fhaf 1 have iead nnd examined fhis apPhcotion and know the same lo bn frue and <br /> conecf All provrsions ollaws nnd ordinences gaveming fhis(ype ol woM will be complefed <br /> whethcr specified hemin or rroL Tho granhng ol n pemiif docs nof presume(o yive aufhonty fo PERMR1f <br /> violafe or cancel lhe provisions ol any ofher sfale or local law regulafing consfnicfion or fho E � 3� 2 _� g4 <br /> perlormpnce olc rs rucfion Thef I em aufhonzad by fhe owner o/th�s pmpeAy(o pedorm Ihe <br /> work lor which a h ahon is mnde and 1 comply wifh Ihe Sfefe Confracfors Law 78.77 RCW and <br /> 296.20 V1�AC. <br /> J� �� �� - - <br /> 5�};nelwe D te <br /> ae�ism iorvn <br />