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i� - - --- -� - - -- -�------ - ----� <br /> � E�.ECTRICAL PERMiT APPLICATION i <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3�00 CEDAR STREET, EVERE?T, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www everettwa org <br /> i j/--/ �� 3 <br /> I C-,� i l—/a/ <br /> i ! <br /> i I � � s� r��_ RE � �✓�71� �✓k, ;�aoa I <br /> PROJECT ADDRESS <br /> �., IT`! �F � ��/� Efi � <br /> O�vnar fvlailAdtlress C�ty StateiLp Phone <br /> S�UD / �tG � � I 1 I � I .S�` t'��,e� rr ,LfNcL c✓A'/ Ev�,e�,i v�9 r`�1 ab' � <br /> Tenant �daii Atltlress Cdy Slateilip Phone <br /> �/jFlL ELeCTyQIC � �]D�� ML�JOl�G�1GL �(� Ev[a_,�� Gi/;A `�g1�� <br /> EleClncal Contractor 7Aad Address Ci:y StatelZip Phone <br /> ti z S' ,i s� i�ao <br /> I� �i9NLEEl �1.2G (� 1.7 .� 3� ���r <br /> State L`cense Number Contract Price of`Nork <br /> Proposed Use of Building Conlact Person (Plan Rev�ew) I <br /> i <br /> I I <br /> Square Footage (If residenfi�l new conslruction, remodel or addilion) ' <br /> Number of devices Qf low s��l�age) <br /> DescripiionofWorkloAeDone C.i�CGI��"r TJ IN�pD1Q � lE�jc�?T n�R CpN/J(7(DNE✓Q <br /> `�— /�00i TD✓� 7/tNI1 I <br /> — — I <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9?OS � ��5� <br /> I heroby certily thaf I have��ad and examined Ihis applicalion and kno�v fhe same(o Ge frue and <br /> correct. All provrsions ol la�vs anU ordinances governing thrs type o/work �vi116e ccmpleted <br /> �;helher speci(ed herein or noL The gran(ing ol a pemiil does nol presume 7o give aufhorify to PERMIT# _ <br /> violafe or cance/lhe provisions ol any other s(a(e or local law regulating consWction or Ihe ^ � ,�' I � O I <br /> perlormance o/construction. That 1 am authonzed by the owner oRhis propeRy to peAorm Ihe t <br /> �vorh lor which applicafion is made and I complp wifh fhe Stale Contiac(ors Law 18.27 RC W and <br /> 296.20 WA�C. — <br /> � �, i - � � � ao� 3 <br /> —SignaWre �� Date <br /> r.t:�se�v,a�r� <br /> 1 _._— --__ _— _ <br />