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ELECTRICAL PERMIT AF'PLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 g �� <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org --(��- <br /> C 130g`� <br /> '�.3�a ��.M. SY tzE�t �t 8�.o Z <br /> PROJECT ADDRESS <br /> z3� I�i..e�, Si Eu�...�rr Wk4�;sa� �laS �5(„-4aot <br /> St `'� S��`f7�u' l� C�ry SlatelZip Phone <br /> Ownef Mail Address <br /> Tenant Mail Address <br /> City State2ip Phone <br /> ��,t�.l ,�,T� ,_cc��,� 3s�s < u��+.r s� �.,�,a -�T l.�lA/4.:t� vi �s z�Z- �csq <br /> Eiedrical CoNractor Mail Address <br /> City State/Zip Phone <br /> M G�„�n � � L O U� [Y� — Contract Price of Work <br /> State License Number <br /> r �x- u! Sti �� T ���- DvOteK <br /> ,�y,�} R Contact Person (Plan Review) <br /> Proposed Use of Buildin5 <br /> Square Footage(If residential new construclion, remodel or addilion) <br /> Number of devices (If low vollage) <br /> Description of Work lo Be Done: <br /> -� �_ b��o_�,St lY�l�z-YEuaa�T 7ancF.t _ l�,C_�-/L� -�_/1r°t� <br /> Q.t b�t��'.��QrY� � <br /> FEE <br /> f C UC`� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 J <br /> 1 hereby certily that I have�Ead and examined this applicafion and know the sarne fo be true and <br /> icorrecL All provisions o(laws and ordinances goveming this type o(work will be completed <br /> �vhctherspeci(ed heiein ornot The granting o(a pemiit does not piesurne to give aufhonty to PERMITr� <br /> violcde orcancel fhe provisions o/any othersfate orlocal low re ulatin constnrcfion or the ? —, / I <br /> �✓o�k Ior�vf�ch anpl c(at o'�s made and�l cornplyevth the State Co iftn<�ors'La�v 18 27�RCW and � I ✓J� O�`v <br /> 296.200 WAC. <br /> � � d4L ( 2o63 <br /> Signature <br /> Date <br /> REVISED:U:W17 �� <br />