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ELECTRICAL PERMIT APPLICATION <br />PROJECT ADDRESS <br />O�mer <br />Tenant <br />Electrical Contracto� <br />CITY OF EVERETT PERMIT SERVICES <br />3100 CEDAR STREET, EVERETT, WA 98201 <br />42r257-8810 - FAX 425-257-8867 —www.evereitwa.org <br />Matl AdQE�55 <br />Mail rless <br />a 1+�� � � a <br />Mai ahdass <br />��Q� � Q��� �6� <br />Stete Llcense Numher <br />��\Qt.i � _ �1�� �V' 1� <br />Pto ed Use of BWlding <br />�333� 5��"Evere,tt m�,� <br />Square Footege ilt resldentiat new const�uction. remodel or addllloni <br />rny <br />7`3 `�3 <br />G i3a��16% <br />Phone <br />Phone <br />lir�;�c�,��-�(35- �013 <br />� statorc�p Pnone <br />,� <br />Cont act Pilce of Work <br />Jn� I C'i� 'R � GNA��1 <br />Conlect Person �Plan ReNewi <br />��o- 43�'—�i3 <br />Number oldeNces �I/to�vvoMegei <br />p . Nf�L�_�.� __�/��� �' � �v> �.� ��,,,� F � <br />DescilllonofWorktoBeDone: _�__ „ i/�-���_ <br />_�%(.._�l� _I/vl._i),�/'✓«2 �;� --�-�—����_—Gc�.1�9'��rLf __o�v G� _N��� <br />CTf OF EVERETT LOCAL SALES TN( CODE IS 3105 <br />f he+BDY ce+tM' Me! 1 Aeve read a� eremine0 fMs eppkedon snd Anowlhe �ne to beWB etrd <br />carecc ar provl�ne a rewe ene mow�er�csa 0orem4g aNa t�pe d rw8 w� ne oomp,arsa <br />Wi�eMer apeelfkd he�eir+ or nof. 7he grnrdhg d e pem�t doee nof p�eern+re 10 grve eutlro+it�+ to <br />v+olafe or car�cal tl�o provl.dans a nny otAers�} ar Aocel lew ragtdeNng co�sbuc�on or Me <br />perR�mencs d oorbbtnc6bn. 1haY ! em etqhofll�d by fhe o��e► ol WsO�b' to Perlbrm bAe <br />� b.+aMcn ey�xuuo� ��� en�.rtvmar,� w�rn are sre�e co�necxaa cew,a.z�,�cw e�v <br />28B2P0 WAC. � / / <br />� <br />pevisto S2re� <br />FEE <br />��OD <br />PERPIIT� <br />E I�O� -I �� <br />