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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, Vb'A 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />iccZ T'-tc�t�a � �Jc S� <br />PROJECT ADDRESS <br />�n,�Il�u,,� � . t'wl�W��/ 1��.��k �. <br />Owner Meil Address <br />Tenant <br />Mail Address <br />� �,.c � S� `�`�% W <br />c�ry <br />Ciry <br />5 —6—�3 <br />� �3oS—o33 <br />:�.��-vd� Q�i�� <br />State/Zip hone <br />��{ss) 3nE-7,� <br />State/Zip Phone <br />N�14 Q,a,�� �L;�S wm�k <br />ElectfiCalContraCtof MailAddress City State/Zip Phone <br />Sta�e License Number <br />Proposed Use of Building <br />Z 1 O t�1 <br />Square Footage Qt esiden�ial new construcUon, remodel or addilion) <br />Number of devices (I( low vol�age) <br />Description oi Work to Be Done: <br />f�vl � d�'�C �/`�' u � C 1 r �1i��7'� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31Q5 <br />Contract Price of Work <br />�lll ���Wi/ ��'-c);c8-1Z�-� <br />Contact Person (Plan Review) <br />�cS�rcl �Je.awrrt <br />1 hereby ceRi(y !hat 1 have read and examined this application and know the same to be true and <br />correcL All provisions o( laws and ordinancas goveming this type of work will be completed <br />whether specified hercir or not. The granling o/ a pertnit does not presume to give authonty to <br />violate orcancel the provisions o(�ny ofherstate orlocal law ragulating conshuction or the <br />peAormance of constru tion. That I am aufhonzed by the owner o( this properiy fo peAorm the <br />work /or which applicat on is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />�( � ` ��1a��3 <br />rr�v3.xram� <br />FEE <br />75°-% <br />PERMIT# <br />E1�0�--O�s <br />