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ELECTRICA� PERMIT APPLICATION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br /> .�' S�� �- csv, k�a�,n� <br /> PROJECT ADDRESS <br /> 1 (� / �{.� 5 <br /> ��1iC,1 iJ(�L� l ���� L-C�l� �c�J1CA f\lc ✓�. l I l,.)� ��-l�i 'GSG7 <br /> Owner MailAdtlress City Stale2ipnq�Q I Phone <br /> "I V <br /> Tenanl / � Mail Address City Stale/Zip Phone <br /> l�lC )/c�� �rG� I L ��.� -�i �� �� ��� Yl D� 1�L� �.v� �-�J � —f !-�] <br /> E eCl triCal Contfaclor Mail Address City Slate/Z�p Phone <br /> �-ra>--a�3 qy� <br /> /f� c vr �<� �� 1 � � ���'� � I <br /> Stale License Number(required) City of Fverett Business License Number (required) <br /> �O�'� , °o <br /> Proposed Use of Building Conlract Price of Work <br /> Square Foo�age Qf residential new conslruction, remodel or addilion) Contact PersonfConlacl NumbedEmail <br /> Number of devices (If low voltage) <br /> Descnption of Work to De Done: �,��� �— f 1/ � C �(�� <br /> c"`c.Q d Sl�-,��� c �� <br /> T � � , �_ `, ; -� L��,����,t,�.� <br /> FEE /� <br /> CITY OF EVERETI' LOCAL SALES TAX CODE IS 3105 �J� _i <br /> (i <br /> 1 hereby certiJy fhaf I have read and examined this applica(ion and know lhe sarne to Ge true and <br /> correcL All provisions ollaws and ordinances govemin9 fhis type ol work�vill Ge complefed <br /> whetherspeci�ed herein ornoL The granting o(a pemiit does not presume lo give aulhonty fo PERMITN ' // <br /> violafe or cancel the provisions ol any ofher sfafe or local law regulafing consWclion or the E l �05 �O '/" <br /> pedormance o/consWcfion. Thaf I am authorized by the owner o(Ihis property to perlo�m fhe <br /> woric lor which applicalion is made and 1 comply v�ifh the State Contracfors Law 18.27 RCW and <br /> 296.200 A <br /> S —U � <br /> ignal e - Date <br /> REV�SFUGEGY.'01� <br />