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- - '_' '_ '__ __ .. --- .- <br /> ELECTRICAL PERMIT APPLICATION I <br /> I CITY OF EVERETT PERMIT SERVICES i <br /> 32G0 C[UAR STREET, EVERETT, UVA 98201 <br /> � 425-257-8810 - FAX 425-257-E857 —�v�w✓.edereltwa.org <br /> I <br /> I <br /> ZO/g Cf7L�y /�tVE � <br /> � <br /> PROJECTADDR[SS <br /> iP�TE2 Q1J.�1�G .zm�o �3S- 5'/9/ <br /> Ovmer h7adAddress City Slate2ip Fhone <br /> I <br /> ienant MaAAddress Cn State/Zip Phone � <br /> i _/��C,�,�; �ec,c�i7lrv ca itilV <br /> IEleclricalCoMrad r Ma�lAddress Gty SlatelZip Phone <br /> NIGGwr� coo3NT- — <br /> Slale L icense IJumbcr CoNrad Price of Work i <br /> � �K E i l7 lA t�C�,)( I <br /> Prcposed Us�of 6uilding Conlad Person (Plan Review) � <br /> i <br /> Square Footage(I(residenlial new construdion,remodel or addition) w C� � 3� ��v <br /> Yumber of devices(If low vollage) <br /> i <br /> Cesciiplion of Wo�k �0 0e Done:R�u�I RE C]C SI\I f� � ���LHGD Gf�R��Cr� l - .t0 Al.If� '� <br /> I <br /> _,_�.o V U• V FG30 E 2. A o t�°f—DA�8cat4�R.D NEATE�Z.S I <br /> u�er�rRs �i- .sm n zqv v cr�ccu�( New t i zo A a Yo v e« _h�� ! <br /> FEE � <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 i/� Qd <br /> !hereby ceri�ly that I have read and examined this applicafion and know�he same to be lrue ard � <br /> correct. AU provisions olla��s and ordinances goveming fhislype o(�vork wdl he compieted <br /> �vhetherspeci/icd herin ornoL Tho granfing o(a peimd does not pmsume to givc aufhonty fo PERMTTN <br /> vielaleorcancelllteprovisionsolanyofhers(ateorlocalla�vreyulafinycansbucfionorfhe r ��D ' ` Q�O <br /> perloimance o/constniction. Thaf I am aulhonzed Gy fhe o�rner ol Ihis property to peAorm(ho C <br /> work/or�vhich app/rcation is made and 1 comply wifb the Slate Conlrac(ors Law 18.27 RCUYand <br /> 296.200 VVAC. <br /> J�/�/ /� 7 — �s <br /> S�ynature � Dale <br />