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� —� - — <br /> i <br /> ELECTRI�AL PERMIT APPLICATION <br /> CITY OF EVERETT PERNiIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br /> � � _i'j-.« <br /> Ciuoi ��`7l� <br /> 13 3 O � o vrn!Oc ��� �✓ e <br /> PROJECT ADDRESS <br /> Nu ��� l �Q�l�� �330 ��IM �� �rN / ` U^P ����Ve� I�V � ! O�� ( <br /> IOwne� Mail Adtlress City Stale2ip Phone <br /> Tenant Mail Adtlress C�ty StatelZip Phone <br /> 2a�-`t ��f 75�5 <br /> �u��(e Y � 1 eG ��l� � 2 Z(n�5"% S � (�-1 L I t,�l � 9 SSc �13 <br /> ElectricalConiractor MadAddress City State/Zip Phone <br /> � U� �; �� � � oa � �� N <br /> State License Number Contract Price of Work <br /> �� S � <br /> Proposed Use of Building Contact Person (Plan Review) <br /> � q��- � <br /> Square Footage Qf re dential new consiruclion, remodel or addrt�on) <br /> Number of devices (If low vollage) <br /> I Description o(Work to Be Done: ��' {2�B L�P �b�� � ��[ e /�L?d� f �G� fJ 4 ' <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �55 W <br /> I hereby ceRi(y that I have mad and examined this application and know(he same(o he bue and � _ <br /> correcf. All provisions ollaws and ordinances goveming Ihis type oI work�vill be completed <br /> whether specdied heiein ornof The g�an(in9 0l a permit does not presume to give aulhonty fo PERMTT# <br /> violate or cancel the provisions o�any ofher stale or local la�v regu'afing construction or the ��� r-� I _ O r O <br /> per/ormance ol constn�ction Thaf 1 am aufhonzed by fhe �wnerc7lhis propeRylo perfonn the U <br /> �a�orfc Ior�a�hich app6ca(ion is made and I comply wifh the S(ate Confraclors Law 18.27 kCW and <br /> 296 200 WAC. <br /> _ ��'����/`O /- /3 — I L/ <br /> SignaturS Date <br /> RFV�SED 140'17 __ I <br />