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F� . <br /> — --, <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � `3 ,13 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> �= w13oN-�l <br /> �UL" l�s �e�� l�J�- G1�2o3 <br /> C�-U�:,� <br /> PROJECT ADDRESS �(2 S <br /> J �c�2 E 25��`x�2 Q�cE�t� CU �Yz �77-476 <br /> e � ec��1�r� Pno�� <br /> Mail Address Ciry Slate ip <br /> Owner f.(Z s <br /> Le�� �h �s � �2 �so��� Dc �:��sP'� ��� /�szo3 3is- s�oi <br /> -g��2iP Phone <br /> Tenant�� Mail Add ess ���1' <br /> J��� d cvvt e t— <br /> Eiectrical ConVactor Moil Address �'�1' <br /> StalclZip Phone <br /> Slate License Number <br /> Contracl Price of Work <br /> sl��cfl� �4(7'tl/`f — ��`) Ic1/Ci�lc� � -- <br /> Propo d Use of Buildmg Contact Person (Plan Review) <br /> Square Footae�e pf residenlial new conslruclion,remodel or addition) <br /> Num6er of devices(Ii low voltage) /� <br /> /, �q /� �}(�cc I�cX C�C"GJ11 �J ��'11B�� "loi" �L'St'rX..UiSCcY <br /> Descriplion of Work to Be Done: Hd'GY 4 � <br /> J/f1d(c� u/4 f'"�'n3 �{S (`E"zu�`S`�� Odi i.U1�2 1✓� 4 ' �L�'Y1Q. ' <br />� Url.�<<�e i.ii��-�r�,� 4�'1cY �.+-�o c�PP�t4Y1c�� '�M 7't��l �c,dYVl. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 �7�� �� <br /> I hereby certily fhat I have read and examined this applicafion and know fhe same fo be 6ue and <br /> correct All provisions o/laws and ordinances goveming this type of wodc will be completed <br /> whetherspecified he��in ornoL The granfing o(a pemut does nof prosume fo give aufhonty fo PERMIT# <br /> violate or cancel the provisions of any ofher state or local law regulafing consfruction or fhe ��I�O� _ �O � <br /> pedonnance o/r,onstmction. T�at I am authonzed by the owner ol lhis property lo pedonn fhe � <br /> work I which applicafion i��de and I comply wifh Ihe State Confracfors Law 18.27 RCW and <br /> 29 200 AC. <br /> f� y-�- l <br /> Signature Datc <br /> ,:r✓rs�.��;:�i <br />