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i-- -� — — -- <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREF_T, EVERETT, WA 98201 <br /> 425-257-Sd10 - FAX 425-257-8857 —www.everettwa.org <br /> � <br /> >�'n f ��eve�t � �/E <br /> PROJECT ADDRESS <br /> � <br /> I <br /> Owner Mail Addrer.:: Gry SlatelZip Phoce <br /> �vev� �TV�� Frv ;��c>� ���e�t�+ A�e ��lev 1,J ri5�.1.�( 1-fi5-973-� <br /> Tenant Mail Address I r Ciry State2ip Phone <br /> ��00g�7�� /I�/Q.(J�C ( <br /> C:Ui r4 v I� ��lr�a wtC-�{i X1��l,tt'S, �+c. L�/VI�AtJ�tX.I �i� /9�O�f'7 S -��1�'�l <br /> Electric Contractor Mail Address Cily StalelZip Phone <br /> �/'�� �UT�� � � S � � ���5�'c� <br /> S(ate License Number Contract Pdce o�Work <br /> C�u.,����-���� I <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Foolage Qf residential new consWclion,remodel or addilion) <br /> � <br /> INumber of devices(If low voltage) <br /> Description of Work to Be Done: L nL1 V1-� .�4 `,Ti,ct V�C�I J N� (�U�� I�L'�jC��C' �i��a ���� <br /> I <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 7 �-'�-' <br /> i � I <br /> 1 heirby ce+tily that I have raad and examined this application and know the same to be ln�e and <br /> correct All provisions olla�vs and ordinmices goveming tbis type o/work will Ue complefed <br /> whether specified herein or noL The granting ol a pemiit does not presume to give authonty to PERMIT# <br /> viola(e or cancel the provisions ol any ofhor state or local law regulating constnic(ion or the 7 ��/'� <br /> peAomiance o/constniction. That 1 am authonzed by fhe owner o/this property to pedomi fhe E I ,C' 1 , lJ�(j� <br /> �vork Ior which application is made and 1 comply with the Sfate Confractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> /�ir � 7�� ��G/I � <br /> � ignaWre � Dale <br /> iz6msm:�zo�u <br />