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i <br /> � ELECTRICAL PERMIT APPLICATION <br /> CIYY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-881 Q - FAX 425-257-8857 —www.everettwa.org S _� —/3 <br /> C�3o5-lX7� <br /> ��a � ✓�Ue,fq Q�/ 1 �9� <br /> PROJEC"i ADDRESS <br /> Ownef Mail Hddress City State/Zip Phone <br /> CL,�v /yt3�,,f�n� 13 ai�% Pl. S�. „�'��1��// �d-�zi �rzs v�P . ��v� <br /> Tenant � MailAddress City Slale/Zip 3�' JPhone <br /> Y � r/2ou <br /> �l/�;�u�,�� ��cr�e � ��'�zl .�'I�,l�'v6" �� � �,, Lv�_ 5�223 <br /> Electrical Contractor <br /> MailAddress City State/Zip Phone <br /> /YI��N.�,� # ��z Pf= ��� <br /> Stale License Number Contracl Price of Work <br /> J �p S�c��a l ��,%� i�i��en.-�,�,-P2 <br /> ^' r\� ��`�� Contact Person (Plan Review) <br /> Proposed Use of Building <br /> Square Footage Qf residential new construclion, remodel or addition) <br /> Number of devices(I(Iow voltage) <br /> Oescriplion of Work to Be Done: <br /> � �J q,l-� `�r „�- d�?�;'P <br /> j3�.f�� �I Ne w C � �c, 'T� <br /> FEE -1 <br /> I ��CLJ <br /> CITY OF EVERE7"f LOCAL SALES TAX CODE IS 3105 4 �— <br /> 1 here6y ce�tify that 1 have read and examined this applicafion and know the same to be true and <br /> correct. All provisions of laws and ordinances goveming this type ol work will be completed <br /> whr,ther specified herein or noL Tho granting of a permit does not presume to give authonty to PERMIT# <br /> violafe orcancel the provisions of any otherstale orlocal latv regu/afing construction or the E �3 � � _60�� <br /> performance o(construction. Thaf 1 am aulhonzed by the owner of this property to peiform the <br /> work(or which application is made and 1 comply wilh the Sta(e Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> '��'7���'%� . <br /> Signature Date <br /> FEVIS[O Y.0/13 <br />