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12/11/2019 15: 5: FAl 425�5J89J4 Eversreen Secm•StY f�002 <br /> � � <br /> ELECTRICAL PERMIT APpLICATION <br /> CITY OF EV�F�ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-II810 - FAX 425-257-8857 —www.everettwa.org �a— �'��'3 � <br /> � I � /2 -D� <br /> �-1'1 � � CxtrC�n.�,t� � <br /> PROJECT ADDRESS <br /> T�tz��s �wr.�ex�s� a3i'1 ��`-++� P I ac�s� �,1q q�v i a, <br /> Owner Mnil ACCress City Stale2ip PhonC <br /> TCndOI �dail Atltlre,s Ciry Slale2lp Fhone <br /> L�c�-3�t8 - <br /> ��� or�hrl� �I I ��»�ad,wa.�.-� �O� ��� �Y�' 3g�5L7 <br /> [leqncai nlractor A�(yj�Atldn:55 y Slate2ip PhOnC <br /> �v� �szl �a�'� � a`to� . la <br /> State L�cen,e Number Contract Pnce of Work <br /> _____�S1Al.p.v�k�ov� ��Q.�.�1 M.c�.rra.� <br /> Proposed Usa of Building CoMad Person (Plan Review) <br /> SquarC Footage(I(residential new conslruction, temodel or addilion) <br /> Number ot de� (If low voltage) <br /> Descripiion of Work�0 6e Donc: �'1�.�� N ` I lJF' I/O� U�I't'(/�V�►'C_� <br /> Qes�t�t..�,r�k,a..4 � �, ��1- � J <br /> FEE <br /> CITY OF EVERETT LOCAI.SALES TAX COUE IS J105 <br /> I hemby ceArty fhat I have read nnd examinetl lhis oppGcation nnd know the sama to be fnie and <br /> r,orrecf. nnpruvisions o(lews antl oN�nances goveming fhis rypu olwork�vill he comnleted <br /> wherhr.r sped(ed hero�n or no�. Tbe grontln,q of a pormit Uoees not presume to give aufhodty to pERMITlt <br /> v�ol�te or cancel thc provislonr,ol any ofhor sfa�e or locnl Inw repufating conslruclion or ihe � <br /> po�Ionnancc o/consf�ueflon. Th�f 1�rn nuUionecd by fhc ownor o/(hls pmpr.rty fo perfortn thn � 3 ' Z'G� �j <br /> �wrk lor which opplica�ion is modc ond I eomply�wth thn Sfatc Con�roetors Low 1 H..7 RCW antl <br /> 29G.200 <br /> � ial � � li3 <br /> �`5ign����� V�,� <br /> REv�9COl:NU <br />