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�---- _---- - -------- - - -- <br /> ELECTRICAL PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STR[ET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX425-257-8857—ww�v.everettwa.org � �� ��� <br /> [_ ��OS - III <br /> ��-o z �u� ��° `��/,Gu�, �/� <br /> � <br /> PROJECTADDRE55 <br /> �d��� ✓��vC1l�f1Cr,�/� ��OZ ����� �� �/�c.�1 � �/� /�v�0� <br /> Owner MailAddress Cil State2ip Phone <br /> �y„�_ y_ <br /> `�' � <br /> TenaN Ida�l Address Ciry StaleRip Phone <br /> U%l��/w� <br /> Ele[tricalConfractor MailAddress Clty Slate/Zip Phone <br /> 51a1e License Number(required) oL pf/��{y Cityof Gverett D�siness License Number(required) <br /> 7 � ��� <br /> ��7�1 >�C�Si1,_�j��.y>•� ����� v- /(�� !t't_d,GGL� - --- <br /> Propo;ed Use of f3wlding , Con!raet Pnce of Wak <br /> .� � 3 � � <br /> Square Fr,otage(If residential new constmclion, remodel or addilion) Contacl Person/ContaU Number/Email <br /> tJumbcr of devices(If low votlage) � <br /> ;��a� �� ��-�r/ _���� <br /> Descriplion�o7f W-ork to Oe Done: __ _ --- -- - — <br /> �77,r'it.('il� fi''?� l' -� ' - <br /> --�---- <br /> FEE <br /> CITY OF EVERC-TT LOCAL SALES T�X COOE IS 3105 S /� Q a <br /> � <br /> 1 Or,roby cerLly tfral I havc read and examinr,d this opplir,a(ion anJ Iu�o�v fhe same lo he(rue and ___.—_ _ __ <br /> r.unecL All provisions r,(I��ws anr!ordin�nces govemrng Ilii:lype ol wod<v�ill be complefeA ----- ----- —�— - <br /> vihr.lher speciGed hercin or nol. ihr, granfuig o/a permif does nol presumo fa givc aidhority fo PF.RI�IIT# <br /> violafc or cancr.l lhc provisions ol any ollrr.r slafc or locai/aw repulafing conslnicfion orlhc <br /> pedorm�nce oJ cons(nicfinn. That I run aulhorizr.d hy fhe owner ol fhis pr��perty to pr.rfonn Ihe E '�J7� � // <br /> e:ork/or which applicafron is maJe and I comply wilA Ihe Slale ConOactors La�i 1H27 RCW and � <br /> 29&200 WAC. <br /> �/��/��2��"��o�--- � s�!/�J" /J <br /> Si�nafure Dale <br />