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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 425-257-8857—www.everettwa.org <br /> (� -a3 --i� <br /> Zso I �u��rl C- i s �6--� �� <br /> PROJECT ADDRESS <br /> 6A2� A�10��r1 J �"-'�� '1T tsr � � 20 l `�zs Z>"2-3�/ � <br /> Owner IvlailAddress C�ty State/Zip Phone <br /> Tenanl MailAddress Ciry State2ip Phone <br /> �ZS <br /> K2��,� � �� c,Q�c.�� � P� �x S� ��rr �zoa 335= / <br /> EIeCUiCalConiractor Ma�lAddress City Slate2ip Phone <br /> � (Zy}-SS�C.�� 7��- ��1�5 <br /> State License Number(required) City of[verett 6usiness License Number(required) <br /> (Z�'s �O�-rv�� <br /> Proposed Use of Building CoNract Price of Work <br /> Square Footage Qf residential ne�v consiruction,remodel or addilion) Contact PersoNContact Numbed[mail <br /> Number of devices Qf low vollage) <br /> Descriplion of Work to E3e Done: � r"��E Iw A"mY S���r� P�'v�j___._ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� �j <br /> 1 <br /> I herc6y certify that I have rcad and examined fhis application and know(hc same fo Ge true and <br /> correcf. All piovisrons o/laws and orrlinances goveming fhis type ol work will6e completed <br /> whethcrspecified herein or noL The granting of a permif docs r�f presume fo give aulhonty to PERMIT# <br /> violate or cancel Ihe provisions ol any otherstate orlocal law regulafing consfrucfion o�the E i 5 b (� � I �� <br /> perfonnance ol cons(niction. That I am aufhonzed by fhe owner ol this property lo pedomi fhe <br /> wo�k lor�vhich application is mcd�and 1 comply with the Stafe Contrar,(ors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � �� � /z3 /� <br /> Siynalute Date <br /> RF.VISEO G395:J i a <br />