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_ _ _ . ---- -- ------ --- - ---------� <br /> ; <br /> �� ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT QERMIT SERVICES �, -� U��3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � �.�6_�(,2 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> Lc� C ��(�� �'�'AD EvG(�G'i' i,t1.�c �(8�'-�' <br /> PROJECT ADDRESS <br /> �./1��f.,(; `�.{kJ'U� <br /> Ow�er <br /> Maii Address City StalelZip Phone <br /> �RNA �t,�X ss5 r �i������ R� ����zcT r�� y�2a9 <br /> -r Mail Address City StatelLp Phone <br /> Tenam �� <br /> '��� ��1-1�_��r r'�i% ri�c� °I5� � �Yc'�w,U �N A���� l,v��- �1�r� ��`l <br /> clectrical Contraclor <br /> MailAddress Ciry StalelZip Phone <br /> r-�g`�, .G� <br /> 1�C 1��1'.rl W F G�� 1 C� co��ice or wo�k <br /> State License Number <br /> �� �r�C- cK�P J��vtr�ti <br /> IProposed Use ol k3uilding :onlact Person (Plan Review) <br /> �.l/�'�l <br /> Square Poota,ye (II residential new con�truction, remodel or addilion) <br /> INumbei ot devices(fl Iew vol�age) <br /> �, Uescription of Work to Be Uone� _��E (C(�t l( l� � /�7�C-!�'�5 /�L~ �l�-� f�`L�P � S _ I' <br /> � �ll Lt v� � �1��7 �JC/�tl�_Ct./__I(,.�- — I <br /> ----—---------- � <br /> FEE <br /> �. qTY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> � JO C� � <br /> I hcrr,by cr.rfily flrat I hnve read and ex;unined ffus npplicafion nnd know(he same fo be tnm and <br /> � rorrecf. All provfsions ollaws and ordinances goveminy Ihis lype ol K•ork will bo comple(ed <br /> �. �•,hefher specilicd hervin or nof. The grnn(ing ol a penni(does nof presumo to givo uidhonty(o PERMIT# <br /> violnfe or cnncel Ilre provisions o/any ofher sfnfo or loct+l law iegulating constn�cfion or fho r I�O j _ I /^� <br /> neAarrnmr�:o u/r.onstn�clion. That I mm�ufhonzed by fho o�vnorollhis properiy fo perlomr t6o C �P lV <br /> wnrk lor which npU��calion is made and I r.onrpty wifh Ih�Sfnfo Contractors Low 78,27 RCW anJ <br /> 796.200 WAC. %/ <br /> � ' � ' �' G�/'�.�� <br /> > , /%�,;%��ti�� <br /> �--�'Signalur / Date <br /> - - - s� <br />