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ELEG tR1��4L PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEF2ETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />I� � ,� � � `� } � �,.� -� � �� y'- � � i� R (� � � <br />�; PROJECT ADDRESS <br />� l�i;�l:� �r.i����i< ��;�r�c�l� I�1�2 �;`rv� ����= <br />i Owner Mail AAdress City <br />Tenanl <br />Mail Address <br />CW�`�1�� <br />� [lectrical CoMractor Mail Address <br />i <br />� <br />i <br />� State License Number <br />-j <br />Proposed Use of Building <br />i <br />i <br />, Square Footage Qf residential new construclion, remodel or addition) <br />Ciry <br />City <br />^ <br />; <br />��%i" �:-{ <br />w fi��� �-30� i_ u�-r��T7 '_,,_x <br />State/Zip '^ 2 S Phone 1 !�' <br />,� .� jc <br />Slate/Zip <br />S�a�e/Zip <br />Conlract Price of Work <br />Contact Person (Plar Review) <br />Phone <br />Phone <br />I�' iJumber u( device- (If low vol�age) II <br />� Description of Work lo Be Done: �L (= M`' �1` ��% �= � � �` '- f��� ��— 1 G S j� V I� �I <br />� � r �l(_ � � � � I �i <br />FEE _� � <br />�I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� '' <br />� hereby ceifily thaf! have read and examined (his application and know the same b be tniu and <br />� ::o�recf. All prorisions o( laws and ordinances goveming lhis lype cf �vork will be complefed � <br />r: hether speci�ed herein or noL The g�an(ing ol a pe�nit does not presume lo give authonty to pERMIT# <br />i �rola(e or cance! the provisions o( any otherslafe orlocal !aw regulal'ng constniction or fhe -� i <br />��. pedormance o/constnicfion. Thal I am authoiized Uy fhe owne� ollhis properiy fo perlo�rn the E ����- I� i <br />� ��.•;o�k /or which application is made and I comnly �vilh fhe State Confraclors Law 18.D RCW and <br />296200 WAC. <br />� '' _r � - �'� �� l�s / � ,� -�.1�,��� ��� � <br />� ; ;rutur� Date <br />��I <br />