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--� --- - — -- - --- --- <br /> I <br /> � ELECTRICAL PERMIT AP'PLICATl�N '� <br /> , <br /> CITY OF EVERETT PERMIT SERVICES i <br /> ; 3200 CEDAR STREET, EVERETT, WA 98201 ' <br /> 425-257-8810 - FAX 4,'_5-257-8857 - www.everettwa.org <br /> I <br /> � I <br /> / OOD S � �vR �2 NI 4 I UJa-C� Zb Z <br /> PROJECT ADDRESS � <br /> , �( /, 1 <br /> -� l, 2C �' �� r , o��{,hU �00/ Utn�cu S{��53GY> �Gl'G�Q W�l. � a/0� <br /> Ovmer 1dad�s C�ty SWte2ip Phone ; <br /> Se f e.��}7 S��t-�;�� ,aoo sE f_ue ra{� Nlc�l ��(L�._y��E✓c.r2�' W dt � <br /> TenaN tAadAddress Ciry State2p Phone ,� <br /> L/ Z % <br /> so:ne 'S0� "jc�nn��nGt�25 /o/Z��E✓' �c�rzz�iU.�T�Sz C ✓� fZ� �.t�/� q �7�0� 870 . 13�z <br /> Electrical Conlraclor 1� AaliAddress Ciry State2�p Phone '�, <br /> n�' <br /> I EGso/7E /�-f� � 28z � F 2s�' - <br /> State Ucense Number Conlract Price of Work j <br /> �, /� �J?Cvtn �Arrit � � <br /> � Proposed Use of Building Contact Person (Plan RevievQ , <br /> i ' �U�� � <br /> I Square Footage (If residenlial new construclion, remodel or addition) �. <br /> i <br /> �, 2 c� <br /> , <br /> � Number of devices Qf low voltage) � <br /> � Descnption of Work to 8e Done�. �o:��9t y n I�c4�r O N C j ��P_ ?�1 5 T4( 19��i' �/1 . � <br /> I <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAR CODE IS 3105 �O� , � <br /> 1 he�eby certily(hat I have read and exmnined(his applicalion and kno�v fhe same to 6e(rue and ��� <br /> cormcL All provisions o//ai•✓s and ordinances goveming thi;fype ol�vork will be cnmpleted --i � <br /> whefher speci/ied herein or noL The gran(ing ol a penmt does nof presmne (o 9�ve authonty lo PERh1IT�7 ' �� <br /> iviolate or cancel the provisions ol any olher sfafe or local law regulaling consWction or fhe ,� � �I i <br /> peAomianm ol construction. That I am authonzed by the o�rner ol lhis properiy lo pedonn the � I j Oq" — O� i <br /> work lor which application is made and I comply wifh!he Sta(e Con�iac�ors Law 18.27 RCW and , <br /> I 296.200 WAC. � <br /> �-/- 9- i3 i <br /> i � <br /> �-�-��tn-� p4 nrra <br /> I Signature Dale <br /> � r.�:,s,i„_,,, __—__ _-___. _ _ __ __. ... . _ ____ _ . _ _� <br />