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� <br /> ELECTRICAL PERI1111T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �^ � 3 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org C�30 5-8 35 <br /> G17p � ��}��n�Gcr� � v/-" <br /> PROJECT ADDRESS <br /> M� 1 +` 5 � � ( StatelZip Phone <br /> Owner <br /> Mail Address City <br /> Mail Address City <br /> StalelZip Phone <br /> Tenanl <br /> 332z l 3z`� s� �`� LY.��✓w�� <br /> � C �l'7l�s�,.� r��7��� cn�c Phone <br /> ElectricalContrec�or MailAddress <br /> City Slale/Zip <br /> � � �Gd�� <br /> � � y�C I � � U�'C L G Contraci Price of Work <br /> State License Number <br /> Contacl Person (Plan Review) <br /> Proposed Use of Building <br /> Square Footage (If residential new construction, remodel or addition) <br /> Num6er of devices(If low vol�age) <br /> �,�� 2� �M,� � � ��.�,� �o ,�� � <br /> Descriplion ot Work lo Be Done: <br /> ,, (=Crcr2� c � �� <br /> FEE <br /> ��G� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRi(y that 1 have read and examined this applicotion and know the same to be true and <br /> conect. All provisions of Inws and ordinances goveming this type o(work will be complefed <br /> �vhefherspecified herein or noL The granNng o/a pemiit does nof prosume to give aufhonty to PERMIT# <br /> violate o�cancel the provisions of any otherstate orlocal law iegulating constniclion or(he r � �O �_ O�� <br /> performance o(consfrucfion. Thuf 1 am authorized by fNe owner o/fhis oroperty to perfomi lhe C <br /> �vork lor which applicalion is made and I comply�vith Ihe State Contracfors La�v 18.27 RCW�nd <br /> z96.zo wA�. c 3 <br /> � - �.. � 7 <br /> , <br /> _� G"" � � Date <br /> SignaNre V <br /> �;EYISE-0 Y:G'�J <br /> _--�_- 1 <br />