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ELECTRICAL P�RMIT A�PLICATIO�I <br /> CITY OF EVERETT PERMIl' SF:R.VICES <br /> 3200 CEDAR STREET, EVERETT, N!A 98201 � �a �—�3 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org �� 3 o b-�G 3 <br /> � �1�� L...�7-lYl���� <br /> PROJECT ADDRESS <br /> �f'�i�,41'N����cr� � �OZ :..��rn�'�'�=� �v'�-�2�"(T � Z� -SZ3-- a3 <br /> Ownef Mail Address City StatelZip Phone <br /> Tenant MailAdAress City State/Zip Phone <br /> �Ass, n; �-��c�('�� c� � � P� �xs�v ��E� �22�. �tzs-�� z�I <br /> Electrical Contraclor Mail Address Ciry Stal?/Zip Phone <br /> �„A�C` �"�`—� �� CoMract Price of Work <br /> Slale License Number <br /> �L`��1 ��uv�� Contacf Person (Plan Review) <br /> Proposed Use of Building <br /> Square Footage (If residential new construclion, remodel or addition) <br /> � Number of devices Q(low vollage) <br /> Description o(Work lo Be Done: _�� ��-•���� 1 ;� ���-�=-=C� ��� <br /> _` (� v (� <br /> i <br /> FEE <br /> i CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 '�G� �O <br /> 1 hereby certily that 1 have read and examined this applicafion and know the same to be true and <br /> correct. All provisions o(laws and ordinances goveming this type o/work will be completed <br /> vehetl�erspecified hemin ornoL The granting ol a pem�it does nof presume to give authonty lo PERMiT# <br /> violate or cancel(he provisions of any other stafe orlocal law regulaling wnsWction orthe r (�CJ� ` i Q� I <br /> per(ormance of constnrction. That 1 am authonzed by lhe or�ner of this property to pedorm fhe C � <br /> , � ���odc(or which applica(ion is msde and 1 comply v,�ilh lhe State Contractors La�v 18.27 RCW and I <br /> �— 296.200 �� <br /> � c-�- Z //-� <br /> �, , � <br /> --�--Su7R� ure ~`��" Date <br />