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ELECTRICAL 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 /> � � .-�s-r3 <br /> 1�3 Ha..�rrr A+/� ��3ie � �� <br /> PROJECT ADDRESS <br /> �utiv�. �oPY. 5H� F�et4eaw (a.v E�e,sZT lJa 16tos ves•,�1•�ts� <br /> Owner Ma�i Address Ciry Slale2ip Phone <br /> N� <br /> TenantO, A'N� � Ma�l Atldre\ss Gry SlalelZip Phone <br /> V V 1 \ YLO►Et1q I"�M+�4[i./ <br /> , r � ' �uea�1T �Je 'l6l0 � •rs!•�39-3fw1s <br /> �onx� �-nwscne.Nr J�'1 2wxE6 �- <br /> Eledrical Contractor Maii Atldress C�ry S1ate2�p Phone <br /> y I�.'�Ste .�' <br /> State License Number Contract Pnce of Work <br /> Mw.��•��� Toora ��� �. L <br /> Proposed Use of Building Contatt Person (Plan Review) <br /> 3Z,8� sF T���- <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done�, FC��E- �-��� ���K�� �� ���y ��1L�t~r �'�(�1T <br /> F�xTMws iN i� '�6 Ra�c�n+T�.� �a.�s�r-�wr� (ts5 'F�x�ua�i,�. <br /> FEE <br /> CITV OF EVERETT LOCAL SALES TA%CODE IS]105 3 � I • l'{'O <br /> 1 hereby certity fhaf 1 have read and examined this appGcafion and know fhe same(o be fn�e and <br /> cortect. All provisions ollaws and o�dinances goveming flus type o/wortc will be compleled <br /> whefher speci�ed herein or not. The granting oIa pemiit does not presume to give autlionfy(o PERMITtf <br /> violafe or cancel fhe provisions ol any other sfafe or local lew 2gu�atmg conslruc�ion or the E � 3 I 0 ' �O� <br /> peAormance ol construcfion. That I am aulhonzetl 6y fhe owne�o!this propeAy tn perlorm fhe <br /> work lor which applicalion is made and I comply with the Slafe Contractors Law 18.27 RCW and <br /> 296.200 WAC. � <br /> �.� �.�✓� /9�2 �/� 3 <br /> SignaWre Dale . <br /> FEVISED 1?09] • <br />