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. 3200 CEDAR STREET, EVFRETT, WA 98201 <br />425-257-6810 - FAX 425-257-8857 — www.evereltwa.org <br />G l[raLf�l <br />PROJECTADDRESS <br />IiN;��PPrSaol7�73-y66 <br />Owner Mail Address City SlatelZip Phone <br />�11 Puy-bl0 rs)'ace/'L( 4 <br />Tenant Mail Address State/Zip Phone <br />Selfn<rP�/4�/� i�f-cP�t�. Rd SNn�orr,�s1� ��90 r��3-397-i606 <br />Electrical Contractor Mail Address � City State/Zip Phone <br />Es gsS3K(� �O�� <br />Slate License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If <br />PP comply <br />295.200 WAC. <br />S gnalure Dal <br />CITY OF E1fERETT PERMIT SERVICES <br />low voltage) <br />