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� • <br /> ELEC7RICAL PERMI� APPLICAI`ION <br /> CITY OF EVERETT PERMIT SERVICE.S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8657—v�ww.everettwa.org <br /> � 7s�� 1.� ��,� � � <br /> PROJECT ADDRE3S <br /> ,C� 2. - � � 7 �S D�/ ���w ��'�¢,�e tt� l��4- �d�•�v3 <br /> wner MailAddress Cily T— Sta�e/Zip Phone <br /> yz�333-8os 3 <br /> Tenan� Mail Address Cily State2io Phone <br /> M1/W A� — <br /> Eleclrical Conftactor Mail Address City Slate/Zip Phone <br /> State License Number Contracl Price of Work <br /> l�/1/.�G2 <br /> Proposed l:se of Building Conlact P=rson (Plan Review) <br /> Squar��ag•(If residenlial new construction, remodel or addition) <br /> Number of devices(Ii low voltage) <br /> Description of Work to Be Done: �u�_�jl� f4✓h�f Ci✓Lu�/Oi-'�r_17f2�1f� `�✓je �- X <br /> 7`� ��r,e�� ��n�-� �3m�. <br /> FEE � 1 <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 ���� I <br /> I hereby ceRi/y fhat 1 have�ead and examined this applicalion and know the same!0 6e frue and _ <br /> conecf. All provisions ollaws and ordinances goveming(his type ol work will be completed <br /> whetherspecifiedherein ornof. 7he grantingo/a permif does nof presume fo givc aufhorifyfo PERMIT# <br /> violaleorcanceltheprovisionso/anyofhe�sta�eorlocallawregulafingconstructiunorthe � � �� 0� O� � <br /> pedormance ofconstruction. That 1 am aulhonzed 6y ine owner o!fhis property�o peAorm the 1 <br /> work tor whicY a plication is made and 1 comply with the Stafe Confractois Law 18.27 RCW and <br /> 296.200 WAC. <br /> � � <br /> Signature Da <br />