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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-885"/ -www.everettwa.org <br /> Ip�8oz E,r�at.x.cEa wq� SrF. �04 <br /> I PROJECT ADDRESS <br /> I <br /> � Ovmer Mail Aatlress Gty State2�p Pnone <br /> I <br /> I D0. WSB�f�y IIYoZ 6�tlttJS,tiN Wv 57E l04 fvbit.J1 WA qY2oN <br /> Tendnt �:a��Ntldress Cily State/ZiD P�one <br /> Sbqcov� �1�SLndc, 4uu3 sr��TN AvE fvt2t7T WA 9'�20� ht+ 3�'l B2Sq <br /> Eler.tncal Contraror L1ail Adaress Cily Stale/Zip Pnone <br /> I <br /> I � <br /> 5bqc.oc..S9'iN 0o Z000 <br /> iState L�cense Number Contrad Pnce o`Work <br /> Proposed Use of�uilding Contad Person (Plan Rev�ew) <br /> Square Footage(II residenUai new construction, remodel or addnion� <br /> i <br /> Number of devices p(low voltage) <br /> Descriplion of Work ro Be Done� F'1� AtN+� �� R4-t-�xaT'E �'L bC.r�c-�S <br /> il <br /> I <br /> I <br /> � <br /> I FEE <br /> CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 �/\ V� <br /> 1 hereby certi(y that I have read and exammed(his applicalion and know the same fo 6e In�e and lJ <br /> correr.t All p/ovisions ollaws and ortlinances goveming fhis type of work wdl be compleled <br /> whefher SpeCi(Cd herCin pi no� The granfiny o/a perrnit does nol piesume l0 9ive aufhonty to PERMfTB <br /> violaM oi cancel fhe pravisions o/any oiher siate or local Imv regulating conshucfion or the � I f f D� - I � <br /> pedormance o�consfn�cfion. That I am authonzed by the owne�ol p�is property to peAomi fhe `� <br /> wor'k lor which applicafion is rnade and 1 comply with fhe Sfate Gontrac(ors Law 18 27 RCW and <br /> 296.200 WAC. <br /> �!�_� f� 1J2z1 'y <br /> �gnature Date <br /> �i v�ScG 1^6'i? <br />