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—, <br /> -- -- — � <br /> 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 /> , ' �3��.,c ��i���.�/'/�� ��� <br /> > > <br /> PROJECT ADDRESS <br /> ��.���oji/i��'/� <br /> Ownef � � MailAddress City StatelZip Phone <br /> �il�ne W�fer D�si�ll��{ Ly ��6y�f�..UJ�� <br /> ���/�i%/9�b'/�� "f'i; d� �/�in� '��✓���� `�U��l/ / <br /> Tenanl MailAddress City Sla� Phone <br /> Geh I ��ecf-n� �'Gc�� '�'c <br /> ��i�i �t'i�'.`/"�-� �%�!��/�/�"��� S� �//�/� TI'.�� r {v�.-� <br /> Electrical Coniractor MaA Addre� Ciry State/Lp one <br /> ��/%�"�%� � ''�'..�2�'�_ ��"� �' O� <br /> State License Number �� � Contract Price of Work <br /> IProposed Use otBuilding ContaclPerson (Plan Review) <br /> Square Footage(It residential new consiruclion, remodel or addilion) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: �� �� � � ' <br /> � <br /> i' '� r � <br /> � ' � �'�J.� � z/�''� �/�_��� — <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 /n � 15 <br /> �v <br /> � !hereby certily fhat I havc read and examined this application and know the same to be f�ue and <br /> � coirecf. All provisions allaws and oNinances goveming this type ol work�vill be completed <br /> i <br /> whefherspeci�ed herein ornot Tho granting o/a permit does not piasume fo givo au(ho�ity to PER # <br /> violofo orcancel the provisions ol any otherstafe orlocal law regulafing consfnicfion ortho r I 3I U_ �•j CI <br /> peAormance o/construcfion. Thut 1 am aufhonzed by the o�vner of this property fo peAarn the C ( <br /> �vork lor which applicafion is made and I comply with the State Confractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Y J //j �� //�/�/�{{'J <br /> �����j` ��/� / / `� /�/�_ <br /> �� Signalure Data � <br /> � . r� .:,-�.nsv��? - -� -- �- � ----- -- — —. _� <br />