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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SER�:ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98'�01 <br /> 42`�-257-8810 - FAX 425-257-8857 —www.=verettwa.org <br /> �7� O /�P ��/ �� �v-2 <br /> PROJECT ADDRESS ��aS�3y-y� 3 <br /> I <br /> l�� „�� ����.�snJ P��� .3�ray �v � �',¢v� �L. ;� �����„sl �.,�; ��aro <br /> Owner Mail Address City SlatelZip Phone <br /> Tenant MailAddress Ciry State/Zip Ph.ne <br /> Q" " 1�'— ��� J Slate/Zi Phone <br /> ElectricalContraclor MailAddress City P <br /> — �s�� vi <br /> Stale License Number Contract Price oi Work <br /> ������ Contact Person (Plan Reviev+) <br /> Proposed Use o(Building <br /> Square Footage Qf residenlial ne�v ronstruction, remodel or addilion) <br /> Number of devices Qi low voltagel <br /> DascriptionofWorktoBeDone: _ t ./.� ' Q�n,.,� �ti�`LS uGi'�Yl� SQ+�Iu L�O•1C�IA�� �e�(,�,� PCt»e <br /> FEE <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 � � -�/v <br /> I hereby ceriily fhat I have read and examined(Iris application and know fhe same lo be frue and <br /> cormcf. All provisions o/la�vs and oNinances goveming Ihis type of wo�k�vill be complefed <br /> whelher speci�ed heiein or noL The granting o/a permit does nol p�esume fo give authonty to PERMIT# <br /> violafe or cancel fhe p�avisions o/any olher sfate orlocallaw iegulafing cons6uction orUie �j <br /> pe�fonnance of consWclion. Tlref 1 am authonzed by the owner olthis property to perlonn the E � I ���— I � p <br /> �vork lor which applicafion is made and 1 comply with the Stofe Contracfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � � 9-� `�/ 3 I <br /> �� fZ � <br /> SignaWre Date <br /> nF yiSE!)v:p�t J <br />