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+ -- -------- � -- — <br />ELECTRICAL P�RMIT APPLICATlON <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CED/�R STREFT, EVERETT, �VA 96201 <br />425-257-881 C- FAX 425-257-8857 — www everettwa.org <br />(0�\5 �� µ�nol��, P��= L�.��-}- �i 5'�a3 <br />PROJECT AUDRESS <br />��.� g ��� <br />ciuoi-��y <br />-��;�.n ��-,,:�h iO3�s �.J ti-+uc�o�;;tk�L �..�.�C.kl- �t,BaU� <br />Owner Ivta�lAtldress City Siate2�p Phone <br />Tenant <br />Eiledncal Conlractor <br />���Of � S\a�U� <br />State License Number <br />SF�2 <br />Proposed Use of Buildmg <br />Pdad AEdress <br />t�1a�l Add�ess <br />Sf .UL <br />Square Footage Qf residenlial new conslruction, remodel or addltion) <br />Number of devices Qf low voNage) <br />Description of Work to 0e Done: �\�e ��` ���L�%� t <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />City <br />Cdy <br />Sla!e/Zip <br />���s ,� �., <br />SlatelLp <br />Phone <br />�ia5-a: <br />Phone <br />� C��o _ <br />CoNrad Price of Work <br />Conlact Person (Plan Revie�•rj <br />1 hereby ceAily that I hava read and eranrined this aPP�icalion and kno�v the same fo be Inie and <br />conecf All provisiona o/ lav✓s and ordinances govem�ng fhis type o/ work �a-ill be comple(ed <br />whefher speci/ied herein orno(. The granting ol a permi( does no! presume lo give authonty (o <br />violafe or cancel the pro�ision5 0l any other state or local law requlafing conslrucfion or Ihe <br />perlomiance ol cons(rudion. Thal l am aufhonzed by fhe owner o/ (his property lo peAonn tbe <br />�vodc lor �vhich applica(ion is rnade and I cernpty wifh Ihe S(ate Con(racrors Law 78.27 RCW and <br />296200 WAC. <br />„ ����� ��� ag <br />Signature Dale <br />RGVISEO ]RD,aJ <br />FEE <br />�^ �� <br />�� <br />PERMIT� <br />El�bl-13� <br />