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_ --- _ _ -- <br /> � -- - --- - <br /> j� ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT. WA 98201 I <br /> ' 425-257-8810 - FAX 425-257-8857 —www everettwa org <br /> � <br /> � <br /> y7�h � ai htL� �n�, l - � <br /> PROJECT ADDRESS <br /> � o <br /> �� -------_ _ ---- -- <br /> � Owner �dail Atlmess Gty Slate�Zip pnone <br /> � – ---- -- � <br /> I Tenant h7adAtldress Gty StaleZp Phone <br /> I� � ������i��t_�c� ld�6 k�-� _ �f�d __ G G�11� �I <br /> _�cin alContractor Ma�iAtltlress G�y State�LO Phone I <br /> I / QL <br /> State License Number Coniract Price or WOrk � � <br /> i <br /> I <br /> Proposed Use ol Budding Contacl Person (Plan Review) <br /> I ISq�.iare Foola�e (II residemial new conslruchon, remodel or adCihon) <br /> I I <br /> I Number of devices pl low voltagc) <br /> I <br /> I Descnplion ol Work�o Be Done _��. (/L � k/ L� I (�l-. , �r.____�Q_r__ I <br /> -- --��---- - --�---- � �- <br /> �- -- -- ------------- � <br /> i ' � J --�_-,�r_ -�2 <br /> , <br /> -�i'�'1_,=-�-����-- ---�-a6-�,5--_N ` � �-- - �`"r,/�—' — � <br /> � �`�i'L-''�' ---- - ----- I <br /> � - <br /> I ---- — - I FEE --- -- - i <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��J I <br />� 1 hen�by certity fhef I havu renA and er�rrrined Ilrrs npplicaGon and knn�v Ifre snmc fo bc f�ue and <br /> ---._._-----..- _ .. <br /> coriecf All provisions ollaws and oidmances�ovemrn,y Ihis fype ol work�vrll be compleled -- - ---�------------- <br /> whrNrr.r specdied hr.rern or nof The g.m(rng ol a pennd does nnt pmsurne fo qive iufhonty fo P[RMITN <br /> violaleorcancelllrepronsionso/anyofheislafeorlocallawn�qulnfmgcons6uc6onnrNre �I � I O_ 0� � <br /> perfomronce ol construclmrr Ilral I anr auUionzed by the uwner olflrrs property(o pedonn fhe <br /> viorh for�vhich �ipphcalinn is made and 1 compty wrth the Slnfe Conlraclors La�v 1 B?7 RCW anA <br /> 296 200 WAC ----� -------- -- <br /> I � <br /> S�gnature _______ Dale .—__-____._ <br /> are,sm v.�nr� .I <br /> --�-------------------------- <br /> '------------- '---- �- � <br />