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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PEF�MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />I <br />�{��5 5�: �;��.� /'�'�.��1 W��_, 5v���, <br />PROJECT ADDRESS <br />�Js�t,� �ti1���� l�� iiiC_ <br />Owner <br />���ftliv,� 1,J�n l�'i� I �I <br />Tenant <br />��,u�l b�J�;w�. �3t��. j„� � 7.�a <br />Mail Address ��N <br />5�wrvu..� u.:� � �� <br />Stale/Zip <br />� , �C f� ��,b� � W/�� �j �2�$ <br />� 5 5L' C=��,��� i�l-.a � lJ�y ,�, � <br />Mail Address <br />Ciry <br />Slate/Zip <br />Phone <br />Phone <br />�- �,^ �- "7��7 �r��. (,���.��:� jT. �='�i>i� �U/<L �l� ��' �a,r,--1�3�-(Z`ly <br />y�rvLh ���'Y���,�c r � <br />Electricat Contractor Mail Address Ciry StaL=/Zip Phone <br />jb 5 �{ D� Gi=v <br />Gv1::t2��-�2�� z:��3 <br />Stale License Number Contract Price of Work <br />���i ���'���.��1C�,.� <br />Proposed Use of Building Contact Person (Plan Review) <br />Square Footage (If residenlial new construction, remodel or addition) <br />� <br />Number oF devices (If low vollage) <br />Descriplion of Work to Be Done: <br />�1.'�'iii,���N�(%�,1 0.� � l�'�'ze � ? � ���'117nu� �Lr.('.� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily that 1 have read and examined this application and know the same to 6e Irue and <br />correct. All provisions of laws and ordinances goveming this type of worlc wi116e complefed <br />�vhetherspecified berein ornoL The granting o/a permit does nof preswne to give authonty to <br />violate orcancel Ihe provisions of any ofherstate orlocal law regulaling construction orfhe <br />peAonnance o(cons6uction. That 1 am authonzed by the ownerolthis praperty to peAonn (he <br />work lor which application is made and 1 cornply wifh �ne State Contracrors Law i827 RC W and <br />296200 WAC. <br />r+tviseoa�ar3 <br />FEE <br />���%� <br />PERMIT# <br />E c ��� i�� —� � � �(,�� <br />