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' ELECT'RICAL PERM11" !�►,PP'LICATIOIV <br /> CITY OF EVERETT PERMlT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everetiwa.org <br /> �I <br /> C <br /> f/3oC j1 Cveti��Ti ,��1� r .�5/�� <br /> i PROJECTAQURESS <br /> � /� <br /> � � �C � (C�`�,l-v�-=112i� ����DC-- �l�L�''�=��N,Ti ��uL�-� �.c���—c-- I <br /> Owne� Mail Address :ny State/Zip Phone <br /> r1� ��� <br /> Tenant Mail Addr=_ss City State/Zip Phone <br /> ��2D5� �Or�k ���Ct��� 2� 73Z ( I ���c:/Y �lA,�-w,a�i �zSa ��� <br /> Electrical CoMraclor Mail Address City late/Zip Phone <br /> //. � i LL�� L� �� � ���� ������1 <br /> ` �E�jSG1' � G� �� 1` Contract Price of Work <br /> Slate Licanse Number <br /> r <br /> ��� � 1 y�.�C iZ C �A ( C��-I`l� I ��ih���`--i <br /> Proposed Use of Building Contact Person (Plan Reviev+) <br /> ��lc� L'1 <br /> Square Foolage(If residential new construclion, remodel or addition) <br /> ;y � <br /> Number of device (If low vollage) <br /> � Description of Work lo Be Done: I� ��� � L/--�h�( �'� � 1 �� s I �'(OC� �U'��'� <br /> �� � �(� � (�� ���6 C � L � � ��U�m0 �n m� �X,`a/i��. �.��� <br /> , II <br /> , FEE <br /> I CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 I <br /> � � � �� ��� <br /> I hereby ceRify Ihat 1 have read and examined this applicatior,and know the same to be lrue and <br /> Icormct. All pravisions ollaws and o�dinances goveming fhis type o(work w�ill Ue completed i <br /> whe(herspecilied herein ornoL The granting ofa pemiit does notp�esume fo give authority to pERM1T# <br /> ; �. violate orcancellhe provisions o(ony otNersfate or/ocal la�v regulafing conslniction or the � l,�j r � - ( C � <br /> ' peAormance o/construction. Thaf I am authonzed by fhe oivnerof this property to perform the V <br /> work!or which application is rnade and 1 compty wi(h the State Ccntractors Law 18.27 RC W and <br /> ' '� 296.200 WAC. ,� <br /> � � <br /> � �� ( �l � �d �� � <br /> ���� � � � I <br /> a�ure Dale <br /> � _. .�_=n�,:_, _ _ _ : <br />