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ELECYRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX425-257-8657 —www.everettwa.org <br /> ) `-f 31 C�� l by (aJ� <br /> PROJECT ADDRESS <br /> � � �-�a.�- t�.,b'�NSn�� l L131 C,nl� (��� � ,�,��1t �,_�- 4�S-a3°�-7 �'7 <br /> Owner M,ail ACdress Cif Slale/Lp Phcne <br /> Tenan� fdailAtld2ss City State2�p Phone <br /> !\�1�'�lN �,°CI�"�CGI W ���7� '1 �� �l)'�7C '0� �.1�_ "lCJ��O 4�s-�9-a3ql <br /> EledricalCOMraclor MailAddress Ciry Slate2ip Phone <br /> I 4�C2-,55F.C,P>°1 `1 QCf OrJC`� ! (� S/ <br /> State License Number(required) Cdy ol Everetl Business License Number(required) <br /> � �-f�S�t��oJ� tC� I <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(N msidential new construction, remodel or adddio�) Contact Person/Contact NumbedEma�l <br /> Number of devices(If low voltage) <br /> Descriplion of Work to�e Done: ZNS"{'p J� � �'r��o.J �OL�'e�S �v �-'S"�t�� Ot�c�, 1 NS�'c �� <br /> �.l�cl��g �oc- �'-,�c��, hla� �c•,�.,� � �Untl..c,,,w Uo...fi FnvJ -- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 /�'�O� <br /> s/ <br /> 1 hemby cerfily thal I have read and examined Ihis appficalion and know fhe same to be We and <br /> cortrcf. All provisions o/laws and ordinances goveming Ihis fype ol work will be comp/efed <br /> whefher specified hemin or no(. The granfing ol a permit does nof presume lo give aufhonty to PER MITN <br /> vio/ate orcancef fhe provisions ol any ofhe�slafe orlocalla�v regulafing cons(nrclion orlhe <br /> perlormance o/consfnicfion. Thaf I am authonzed by Ihe o�vner o/this propeRy fo pe�form the E � �ra_ ��� <br /> wo�k lor which applicafion is made and 1 comp/y wi(b fhe State Confracfors Law 78.27 RCW and <br /> 296.200 WAC.� <br /> C_�`_11.�1�1.� /� � / — ' � - <br /> Signalure Dale <br /> rr[cbCO Can61a ro <br />