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i — <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-885? –www.everettwa.org "1 ,., (O—I� <br /> C �3 0�—�3b� <br /> �3��� ���r� s� r��x.�.�4- wk <br /> PROJECT ADDRESS <br /> Qc.J; t� bc.,��� � �-{��c 8 nPk�.4 S+ �.�'�-a-f- t.Jk <br /> Owne� MailAddress Ciry StatelZip Phone <br /> Tenant MailAddress City State/Zip Phone <br /> L � <br /> }�c���fi�, t,\e�c.�'t �,'�\Cri l35 S+ /Jr C�c n;1� t�-��S 1 l•� ��$' `�v2" <br /> Eleclncal CoNraclor Mail Address City State2ip Phone <br /> W� r i 5���.\�t �+Oc��� <br /> State License Number Contracl Price of Work <br /> ('� hProposed Use of Building Conlacl Person (Plan Review) <br /> � acx) <br /> Square Footage (If residenlial new construction, remodel or addilion) <br /> Number o(devices(If low voltage) <br /> i Description of Work to Be Dane: �\ \���'\ ` �`��"�` �S <br /> . � <br /> I <br /> � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 "'7���(� <br /> 1 hereUy certily that 1 liave read and exarnined tl�is application and know the same to be true and � <br /> correcL All provisions of laws and ordinances governing this type o/�vork tvill bo completed <br /> whe(her speci(ed herein ornoL The granfing ol a pemiit does not pirsume to give authonty fo PERMIT# <br /> violate orconccl the pravisions o(any ofhersta(e orlocalla�v regidafing constniclion or Uie r I �O � _ U� � <br /> per/omiance oI consWction. That 1 arn aulhonzed by fhe owner olthis propeRy to perfomi the C <br /> work lor which applicafion is made and I compty wi(h the State Contrac(ors Lo�v 1817 RCW and <br /> 296.200 WAC. <br /> �/ � al��� �l�/ �U _ <br /> � Signalure Dale � <br /> r..r visFn vzwi� <br />