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ELECTRICAL PERMIT APPLICATION <br /> CITIt" OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 j�.�a0•-/3 <br /> 425-257-8810 - FAX 425-257-8857 - �vww.everettwa.org ��Z`�yp <br /> C� S�' ��-c-�- rY�A� �,�-Y -��� `- � <br /> PROJECT ADDRESS " � <br /> '(� A(��- �'S l'J O `� <br /> Owner MailAddress City � StatelT.ip Phone <br /> ti-IQPr��'� �`� � N 1�'-�'> <br /> Tenant MailAddress City Stale(Zip Phone <br /> t�(L��.s i� ��E'c�� c<tLC.a G� �cS� `�o ��lT'� 5�2r�'� ,�, '�3 g-2 I <br /> Elecirical Contraclor Mail Address City StalelZip Phone <br /> �F�SS�C��97 F�r � ��DO� I <br /> Slate License Number Contract Price o(Work <br /> I <br /> C�lYl�1�-1 C�S-- (Z-�7'h I L <br /> Proposed Use ol8uitding Contacl Person (Plan Reviev+) <br /> Squarc Poolage(If residential new conslruction, remodel or addition) <br /> �� � <br /> Number of devices(If low vollage) � <br /> Descriplion of Work lo De Done: R���--��L—� / � 2�' '� 1 � O I �2 <br /> � �ov(L l�i X-r.J GZ.�S � � Tl-�- ��`�-- �' IX-rti1�S <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CUDE IS 3105 �S . C�/, <br /> /V <br /> 1 hcreby ccrti(y fhaf I havc read and exarnined this applicafion and know the samc(o Gc(nie and <br /> correcf. All provisions olla�vs and orriinances goveming U�is fype ol wo�k�viN 6e complefed <br /> whefherspecificd hcrcin or nof. The granling o/a pemrif does nof presume to give aulhonly lo PFRMIT/! <br /> violafeorcancellhep�ovisionsolanyotherslateorlocallawregulafingconslnicfionerlhe r <br /> peAomianr,e o/consfruclion. That 1 am aulhonzed by the owner ol this property(o pedonn fhe C 1�'� _ �e�j� <br /> work Ior which applicaf n 's mad and 1 comply wifh fhe Statc Confraclors Law 18.27 RCW and � " <br /> 296.200 Wl1C. <br /> 1 ,_ I <br /> Signature Dale f <br /> rrr.vrsro.rvu <br />