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<br /> � ELECTRICAL PERIVIIT APP'LICAT'101� �
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 'i 3200 CEDAR STREET, EVERETT, WA 98201 I
<br /> 425-257-8810 - �AX 425-257-8851 —www.everettwa.org
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<br /> %D�US f�//Y D� ZE�'��TT � �j�z�y �
<br /> PROJECT AD�RESS I
<br /> I �n�G�r O�r1r✓ EoS ii.�r� Sr SE �i�81oz ����u��i- 9�Zo��_ �I
<br /> '� O�,�ner Ata�lAdoress Gty Stale/Zip Phone ,
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<br /> �� Tenant A1adAddress City StalelZip Phone i
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<br /> Electrical �Joniraclo� �v1a�lAddress Cily StatelZip Phone
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<br /> ' Siate License Number Contract Price of Work �
<br /> ,� K�–S�YC",�U�
<br /> r'roposed Use o(6miding Contact Person (Plan Reviev�)
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<br /> Square Foolage pf residential ne�v construction, remodel or aGdition)
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<br /> '� Number of devices Qf low voltage)
<br /> � Description of Work lo �e Done: ���/���G 1/!/�'1� ��L1��-�`--��5� �
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<br /> FEE ---- --
<br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J1U5 T��
<br /> nd lcnoi:��he sante lu be hue and _ ��
<br /> I hereby certily fhaf I have reaJ and cxarnined fhis applicafion a —
<br /> r.orrec(. i:d provisions ollaws and ordinances goveming this type o(:oork r.ill be complefed
<br /> �vhe(herspecdied hemin or noc 'he granliny oI a penait does no(presume fo gi�.�e authonty fo P[Rh1IT# i
<br /> I �ola�e or cance/fhe provisions oI any other stale orlocal faw regulating mnsfroction or the E I�f 03—e�3�
<br /> erfomrance ol crnslnicfion That I am authonzed by(he or:ner o(fhis property(o peAonn the
<br /> � �vork lor�•�hich application is made and I compty�vdh fhe S�a,e Con(ractors Lar� 78.27 RCIN and
<br /> I 296 200 WAC. �
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