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- ---- <br /> - • - ---- -- --- � - - _ _ _ _ <br /> ELECTRICAL PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERYICES ' <br /> i 3200 CEDAR STREET, EVERETT, WA 98201 i <br /> 425-257-8810 - FAX 425-257-8857 -www everettwa org I <br /> � , v�U -a � � <br /> y �3. 0-�`-� <br /> 3003 W Casino Bldq a0-92 � �f ���� I <br /> iPROJECT ADDRESS i <br /> I <br /> IOwner -- �1.1ailADOress- " CdY St�taLp -�_ � ��—� Phone I <br /> IBoeinq � <br /> Tenanl Mad Ada�ess � Cny Sta!e2�p Phone �. <br /> IH6M Electric PO Box 799 Marysville WA 98270 <br /> iElec�rical ConVaclor Man Add�ess Gty Sta!e�Z�p Pnonr. ��� <br /> IER�LECI*077KR $1575 .00 - __ I <br /> State License Number Contracl Pnce ol Work <br /> Proposed Use of Audding Contatl Person (Pl�n Rew�w) I <br /> Square Footage(If residen0al new construction, remodel or add�Uon� I <br /> � <br /> INurnber of devices QI low voltage) <br /> IDescnption ol Wnrk lo Be Done _IllStdll 3 livht._fixtures, _3 receptacles and_ 2 switches . <br /> FEE ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS ]105 C,(�. 7 � <br /> u <br /> I hereby ceAdy fhaf 1 have read and examrned thrs app6cahon and know fhe same fo be In�e and <br /> conecf All provisions ollaws and ordinances govemmg fhis fype o/work wdl Ae complefed -- -� <br /> whefher specfied heiem or not The granhng ol a pemuf does nof piesume lo give aufhonty to pERMITu <br /> v�olafe or cancel pr � rons ol any ofher sfafe or local l�uuegula6ng consfn�chon or fhe / / <br /> perlomrancc con� fi Thaf I a ufhon �y-8 e ownc�o/fhrs property to pedorm Ihc E �`j��� - �/ <br /> work lor whicR apphca on Is made a d f compl ifh Ihe Sfafe Conbacfors Law iB 27 RCW and <br /> 296100 WA - -- — <br /> 3�� l� <br /> Sign lure Oate <br /> i I <br /> ac v�s[o�vo�u � <br />