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r_. ----- -- ---- _---- - -- --- -- -- -- - - - ----- <br /> ELECTRICAL PERMtT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVF_RETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www everettwa.org 1 —'� 6-,ry;-' <br /> EI4ar -n� <br /> l 1 7 o y l�i w.�Y �9 S <br /> PROJECT ADDRESS <br /> C �(ucK' S C Nc v2oN <br /> Ovmer blailAwress Gty Stale/Zip Phone <br /> [' (�t �i( K � S C rT� UI�O.y � <br /> Tenan� Ma�lAddress Ciry Stat^/Zip Phone <br /> _�, �. I'G Tr c2 Sv.�l EGG��iz�c �.�/L 3 32 Z I 31"� ,�T ,s�-✓ L Y�v�.w��� <br /> EleCtriCal ConUactor �da�l Address Crty StatelZip Phone <br /> .�C {�EiE � ouv 13C S �' <br /> Slate License Number Coniract Price of Work <br /> Proposed Use of 8uilding Contact Person (Plan Revievi) <br /> Square Footage Qf residemial new construction, remodel or addition) <br /> Number ot devices(If low vol�age) <br /> Descriplion ol Work to Be Done: w � �� G � ��G rS � ✓- �CG R �a o L C/�S <br /> �__---_ <br /> �/r�✓ G i r6 S <br /> � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I (�� •�� <br /> _� <br /> 1 he�eby ceRily thaf I have read and exarninedlbis applicafion and know the sarne fo 6e(n�e and <br /> conecL All provisions ollaws and ordinances goveming this type ol work will 6e compfefed <br /> whefher specified heiein ornoL rhe gran(ing ol a permif does no(presume(o give au(honty to PERMrfN <br /> violafe orcancel the provisions ol any ofhersfafe orlocallaw regulafing consfn�cfion or Ihe � <br /> pedormance ol constn�clion. Thaf 1 am aufhorized by fhe owner ol fhis propeRy fo pedom�fhe l L-1 Q l _ D�a <br /> worfc lor which application is made and I compfy with(he Stafe Cont�actors Law 78.27 RCW and <br /> 296.200 WAC. <br /> c�GL.—•.' �- �� 1 ' �� � r� <br /> Signature Dale <br /> nt vrseo vlai� <br />