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ELECTRIC�►L PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425•257-8810 - FAX 425-257-6857 —www.everettwa.org <br /> ��-D � ,� �v��err` � �,lA- 98zo � <br /> PROJECT ADDRESS <br /> $kn�-,��I fY�u�'��rl (,L.rC ,�70� (',��� �J¢,�e�f v,l-rt RRZoI /�is-asa.-5�laa <br /> Ownei hlad Address Ci�y Slale/Zip Phone <br /> �",�,� �,� 15rxr E I��n�� Pir��f ial ��hm�-Inn �A^. 2ocb�. 20� 34ny�s <br /> Tenan� Mail Ad ss Ciry SlatalZip Phone <br /> (A�Os� iv� mm�.cn�ca�t,,,, 222(��, �8�74.iS Kon� iJ/ti �1'8'o�a <br /> Eieetrical Contractor M11aA Add�ess City StatelZ�p Phone <br /> i <br /> 00 <br /> LI�FS�ocX qC�y C (o � n� — <br /> State License Number Conlract Price ol Work <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Square Foolage(If residential new construction, remodel or adddion) <br /> Number ot devices(If low voltage) <br /> � �escription ot Work lo Be Done: Q�(4 � ' IoDF� `�U.�021�1P� , <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y cedify fhaf 1 heve read ond exnmined fhis npplica6on and know fhe same fo be frue and ` � <br /> correcf. A!I provisions ollaws and ortlinances goveming fhis type ol work will be completed <br /> whether specified hr.rein or noL The granting o/a pemnf does naf presume 10 give aufhonfy(o PERMIT# <br /> violo(eorcanceltbeprovisionsolanyotherstateorlocallawragulafingconstrucfionorfhe r I � O^'��� <br /> pedomiance olconsfruction. 7haf 1 am au(horized by the owner o/this properry to perfonn fhe C � <br /> work lor whicb applicafion is made and 1 comply wifh Ihe Sfafe Confracfors Law 18.27 RCW end <br /> 296.200 WAC. <br /> ` �-�Z� (y <br /> Signalure Oafc <br /> REviSED 8^N�J <br />