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� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FHX 425-257-8857—www.everettwa.org <br /> I �SrI; r_ 1l�Q�/���D-, ,�A,/ � i Gf� <br /> PROJECT ADDRESS <br /> " E 3� Paove2T��-t l�c 7ys e�L�rVUEAUE C �IoZ S�Atr�,� w.A �iYl�l. <br /> Owner Mail Address City State Zip Phone <br /> y�LJ�� Oc5 �I iUL �v£KGRcriv t.-AY �I�G -v�n.c� u/A �8?�Jl <br /> Tenanl Mail Address Cily Stale/Zip Phone <br /> �6NS /Laf 71�G 1VIA /�.l tiE �Y1./✓& �E"L<1,'�CNA�'1� l�.�A /�iZ2L 3L0-'G7l• 7/bf <br /> Electrical Contreclor Mail AdAress Qly Slate/Zip Phone <br /> S � a � <br /> / G"NS p 1 �YSy� �,.� s � <br /> Slate License Number Contract Pnce of Work <br /> ��a �� n��v r 1�,�.�p����� <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> N�/4 <br /> Square Foolage Qf residenUal new conslruclion,remodel or addilion) <br /> Number of devices(If low voltage) <br /> Descriplion of Work to Be Done: .�NSTQ �"�' T�O (�� ('jJb�'''�`"�` L�7�✓�- �f G✓S <br /> FEE <br /> CITY OF EVEFETT LOCAL SALES TAX CODE IS 3105 �7-� �"v <br /> I hereby certily fhat I have read end exemined fhls applicet� nd know fhe seme fo be true end t/v <br /> correcf. Ail provisions o/laws and oidinances yovemi is fype o/work will be completed <br /> whether speclfied herein or not. The granting o!� rmit doea nof presume to gNe authority fo pERMITJ� <br /> violate or cancel the provisions ol a �r�1e(e orlocal law reyula6np construction or fhe � I�v� - O G� <br /> perlormance u/conshuction. Tha 1 am utfiorized hy the ownerof this property to perlorm fhe <br /> work/or which application is made a'tf�comply withdhe Stafe Contractors Law iB.27 RCW and <br /> 296.2GO WAC. /� � <br /> �� / � i <br /> � <br /> �� ;'=-��� 7/.�i ao�� <br /> SgnaWre /Date/ <br /> r-e.�set�.�zi i� <br />