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EL��TRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> 7�i��' l-�.fl��- c,��� <br /> PROJECT ADD ESS <br /> r � �� . � - <br /> Owner <br /> Mail Address :!} Slale/Zip Phone <br /> Mail Address City Slale/Zip Phone ._7 <br /> Tenant •�,c� 3� � <br /> � ' � z�(I ��s�J ��,^Pr �,JA-y�v3c� �y� <br /> //, �/�����1� �z�. 2-��r�� <br /> MailAddress City Slate2ip Phon� <br /> Elecirical Contractor ! <br /> l�-�G �'� ���37� �ss� �ro _ <br /> �-- <br /> State License Number Conlrecl Price of Work j' <br /> /�/7 / TT�..�c/� 1.+2i/�n <br /> G L('_5/� f o �'� -r <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction,remodel or addition) <br /> Nuinber of devices(If low voltage) <br /> � t �-�Z>/��-r C/�f�I-�� <br /> Description of Work lo Be Done: �. 1� P � ���Vi '� "— �� <br /> FEE <br /> � CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 � �-(,�C� <br /> I hereby cerfify that 1 have read and exarnined(his application and know(he same to be frue and _ <br /> correct. All provisions of la�vs and ordinances goveming fhis type o(wod<<vill be completed <br /> whelher specilied herein ornoL The gran(ing o/a pemiit daes cot presume to give authoiity to PEkMITn <br /> I vio/afe or cancel the provisions ol any other:tate or local la�v regulating conslrucfion orthe r � �C-,� _ 1� O <br /> pe�fomiance oI construcfion. That I am aulhonzed by the ownero/this prope�ty to pedonn the C � <br /> I wo�i<(or�vhich a plication is made and I comply with(he S(a(e Con(ractors Law 18.27 RC W and <br /> II 296.200 WAC. � n <br /> I <br /> . <br /> 'I - ?.�n-�j -c-`� � u�' 2� �� <br /> Signature Date <br /> v;:o�;sr�v7c�7 ____ _—.—__—_—_ —__—_ <br />