Laserfiche WebLink
i— - — <br /> i ELECTRICAL PERMIT APPLICATION <br /> i CITY OF EVERETT PERMIT SERVICES / <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��F� —� j <br /> 425-257-8810 - FAX 425•257-8857–ww�v.everettwa.org <br /> E �3os_oa�� <br /> `�Z�Z �c��i� �s%e `� �z� j ' <br /> PROJECT ADDRESS / � <br /> .itil� /��,,�ii� NlAL C��vJ�/r✓� �d:.'�� (� �cic7 ytS-Si'U_`!/C� <br /> Owner Mail AtlCress Ciry Stalo2ip P�one , <br /> � <br /> I I <br /> Tenant Mail Address City SWte/Lp Phone <br /> �,ti fKelCir�� 1���/'i"y 61� C��S����` k���c.c�Qf Gt/,¢�98��� N2r�t 9-�4� I <br /> +J <br /> Eledrical Contractor Mali Address C�ty SWte2ip Phone 'i <br /> � `E t r <br /> �oMM�u/''�F`1S,rJT q/90o ,«� �, <br /> State License Number � /� Contract Price ot Work <br /> /��t'flGlf��/2� ���� �oyU/� `G.rSiLtEa.G E <br /> V I <br /> Proposed Use of Buil ing Contact Person (Plan Review) ��. <br /> Squara Footage(If residential new conslruction,remoC=1 or addition) <br /> i <br /> Number of devices(II low vo�tage) � <br /> Q , i <br /> DescnptionofWorkloBeDone: ,�elv/C�E f�/�«��t" " �IDCis-1�7�e." p � <br /> /7�'/' Oc�f� �Qe/' �i E.. pl/�r�c�.� s�^/`v�C� ! <br /> i <br /> ; i <br /> � I <br /> FEE I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � 5 �� � <br /> I Irereby certdy thal I have read and exarnined this applicalion and tinow the same to be We and <br /> crorrect All provisions ollaws and orrlinances goveming this type o/work will be complefed <br /> whether specified herein ornoL The granting ol a perrnif does not presunto fo givo aufhonty(o PERMIT# <br /> violate orcancel fhe pmvisions ol any other state or local law regulating conshuction or the <br /> perlo�manco ol consWction. That I am authonzed by the owner ol fhis property fo perform the E l j Q �-. �Z� <br /> wo�k lorwhich plicafion is maiie a d i coniply with the State Confracrors La�v 18.27 RCW and <br /> 296 200 W . � <br /> �,�; ���,�.� S���L�-�� <br /> Signalure Dale <br /> REVISEOYI6'IJ <br />