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i _ - _ _ _ --- -- - ----- -- ---I <br /> � <br /> � ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ! 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810 - FAX 425-257-8857 - www everettwa.org <br /> � � ' <br /> �o/? ��,o.� S T <br /> PROJECT ADDRESS <br /> I <br /> d_���-_�������7Z�1��F ��c�-1!/-�— � m•�-���s-?�ro <br /> Owner ldail Ad�lress City Statei7ip Phvne <br /> �e,. vls��vs�..�,rn-r c�s���a Cla�/r,a..��,�d�_9�o�s i <br /> enan� MailAddress Cily State/Zip Phone <br /> � � i <br /> � � �'/\C l��� <br /> I [ledrical Contrac�or Mail Address Cily Stale/Zip Phone I <br /> I <br /> I <br /> ISlale License Number CoNract Price of Work <br /> � � <br /> I�, Pruposed Use of Ouilding Contact Person (Plan Review) '�, <br /> I I <br /> ; Syuare Pootaye (If residenlial new conslruction, remodel or addition) � <br /> i <br /> i I <br /> : Number ol devices Q(lew votlage) I <br /> I I)�:�scription of\Voik to [�e Done: _S��f/�___.�qy��__(����__(�1Qi?�./«/��� � _ffie�M1� <br /> ' t�h_��u�_�ri12'���B.�s ��.8�� F< s�" �I <br /> _ � <br /> =��/3 �2u-10 , 3- �3 i <br /> ---- -- <br /> FEE <br /> < . � <br /> . CITY OF [VERETT LOCAL SALES TAX CODE IS 9105 � /- 1T 1 <br /> t__ l/L/ <br /> � 1 he�eby ce�Lty Utnf 1 hnve read nnd eaarnlnr.d fNis npplir.ahon and knowtho same lo be frue and <br /> �, correcf A/l pmvisians o/latvs nnd o�tlinances yoveming this type altvoik will bo contpleted <br /> ' r:hc(her speci6ed herein or noL The gran6ng ol�pennit Aoes nol piesurne lo�ive nufhority to PERMIT# <br /> � ���ol,�le or ct�ncel the provisions ol nny ofher sln(e or lucnl lmv regulafing consfn�ction or(ho � <br /> pr�lormance o/constn�cfiorr. That I arn nufHonzed Uy fhe owner ol fhis properiy(o peAonn fhe E I �%%�>� _ ( � <br /> � �•;orl� lor which applicn(iori is rnade nnd 1 cornply wi(h fhe Stnfe Contractors Lmv 18.27 RCW end � <br /> ?9G :'00 C <br /> ! �����U.�l.e�l�/f��f-.� % �?lv � � <br /> ,, �iynature,�' Date <br /> / <br /> I � ia. �� <br />