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,-- -- ------- --� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � — I N '/3 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> � �-3p5-tl�z <br /> 1 i�62� l�►�ou� <br /> PROJECT ADDRESS �pl <br /> � L�c-�nri� c.�<��' �ve+-�{{ c�f!-4 y1s-�Z7�7zv9 <br /> I �i� State2ip Phone <br /> QW� Mail Address Y <br /> StatelZip Phone <br /> T�� � MailAddress ���Y b <br /> � � � <br /> �l £.we�.vy �47..1 �'� S`'� �Cc �,tJ� f�7� 9Yl-G65� <br /> Mail Address Ciry StateiZip Phone <br /> Electrical ConV�r,tor 1� <br /> ��I A ir_ 7pC�� 'y1 y/�� —f �f00 <br /> S `�_ `D ` �� Conlracl Price of Work I <br /> State License Number <br /> J r� Contacl Person (Plan Review) I <br /> Proposed Use of Building I <br /> Square Footage(If residential i��w construction, remodel or addilion) <br /> Number of devices (I(low vollage) <br /> II 6 �f�3Zl�� �Se(�.�wau � ,�c�c� <br /> Description of Work lo Be Done: �K � a � 0� <br /> � <br /> m.s�- 2�.�—s`�-�'v u��� �O;.,..�w �o .u�s�µ:« �F-.,.a1� • - <br /> � <br /> � <br /> i <br /> ' I FEE <br /> IIIl <br /> CITY OF EVERETT LCICAL SALES TAX CODE IS 3105 �j�� - L�v <br /> 1 hereby ceRi/y that 1 have read and examined this application and know the same to be tnie and <br /> correcL A/l provisions ollaws and ordinances goveming(his type o(wod<will be compleled <br /> IIwhefher specified herein ornof. The granting of a permif does nof presume to give aufhorily to PERMIT# <br /> violate or cancel the provisions o/any olher sta(e orlocal law regulating conslruclion orthe �— y�p�-� <br /> per(onnance o(consfnrction. That I am authonzed by the ownerof this prope�ty to pei(orm the E �?il� — !/�'" <br /> work lor hich application is made and I compty wi(h the State Contracfors Law 1827 RCW end <br /> �,_ III 296.2 / <br /> I t�—, 5-���f— . 3 <br /> �, Signatere Date <br /> i <br /> ro„s:rn ar.v i� --- <br />