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ELECTRICAL PERMIT APPL.ICATION <br />CI1'Y OF EVERET`F PERMIT SEP.VICES <br />3200 CEDAR STREET, EVER[TT, WA 38201 <br />425 �57-8810 - FAX 425-257-8857 — www.everettwa.org �2 `�`�3 <br />�/ J/Z—OIJ` <br />Z�'� 3 L����r o�,�� 9�z�3 <br />PROJECTADDRESS <br />s_�osH HAr�1�/4 2�03 LAa�,,•� Da,vP t �/cnc.r�T t,.�.9 9Pzo3 `/zr- s'3- 9- <br />Ovmer Mad Adtlress C�ry State2ip Phone <br />Tenanl <br />69a1 Atltlress <br />Crty <br />StatelZip <br />Phone <br />..� <br />NANl��'' EC�crn,c Src //ll� 22r0 STSC G.9HrS7tvcNJ (.vi9 9��ss' �/1r:33Y-979Z <br />Eledrical Con�raclor Mail Atldress Clty State/Zio Phone <br />N,�Nsce� o i z PA <br />State License Number <br />S F!� <br />Proposed Use o( 6uilding <br />Square Footage Qt residential nev+ construciion, remodel or addition) <br />Number of devices Qf low voi�age) <br />� y�a o 0 <br />Coniract Price of Work <br />Contact Person (Plan Review) <br />Descnption of Work to Cie Cone: /� t P�R � L 2 v� fJM+O � � E ���� �� P� r�Z _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certdy Ihat I have iead and examined this 2pplication anU know the same (o be true and <br />conect. FlII provisions of laws and ordinances goveming this type ol work �vill Ge r,omplefed <br />nhether specdied he�ein or nof. 7he granling ol a pemiif does nof presume fo give aufho�ity (o <br />violafe or cancel the provisions oi any ofher sfate or loca! law regulaling consfruction or lhe <br />perlomiance o/ conshucfion, Thaf ! am authonzed by the owner o/lhis pioperty to peAonn the <br />work /or wh�ch application is made anU I cornply �a�ith the Stafe Conlractors Law 18.27 RCIN and <br />296.200 VV . - � <br />- —� - - — �L/y�/3 -- <br />R[NcCp ;.:C�q <br />FEE <br />T5 0� <br />PERhi(T# <br />E131a-oi5" <br />