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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 —ww�v.everettwa.org <br /> �� �� � (TIZ�N� �v-e �ve��f � 9 �Z � / <br /> PROJECTADDRESS <br /> � Z� os<<I�'a•'d '9ve q�Zo l <br /> �� %�� c li /�Je��uc�2 E�-�a-r y zs - 3�yi�� <br /> Ovmer A1ad Address City SlatelZip Phone <br /> TenaM 67a�1 Address CAy 5tatMZ�p Phone <br /> �/�C/fj�L ��ecf,e�c L� C L yke 51��,rs�S tv� � 9�Z� ,?o�-Ss3-� 29 <br /> Elethical Contrador Ma�l�1Cdress Gty Stafe/Z�p Phonc <br /> E3��Clf T,EL 3�7 7/�/�'I �—�s� � `� -- <br /> , <br /> State I.icense Number Contract Pcce of b\'ork <br /> ��E'S/o�e�C � <br /> Prcposed Use o(�uilding Contacf Person (Plan Review) <br /> yD O Sy ��- <br /> Square f"oolage pf residenlial new conslruction, remodel or add+tion) <br /> Number of devices(II low vollage) <br /> Description of Wark to Oe Donc: �����e �f�� �D� � � ��� �✓�/� <br /> Se�v�cE'_�� ST �/1�e�er ��oo �;.�,,../� �v�, ,�e � aHd _ <br /> � ro���Q ,ry , �"° r-e Nf� �J" ra�C� C(/�Cui �s �-�- �-ti�S �� e .� <br /> ���cse is �u.�� r�o cu� ✓��g Y �� � f-EE � <br /> CITY OF EVER[TT LOCAL SALES TAX CODE IS 7105 ��� O� <br /> I hereby cerhly Ihat I have read and e�amined this applicafion and k��rnv Ihe same(o he Uue and <br /> correcf. A!1 provisions o/Is�vs and oNinances gaveming Ihis rype of�vork will be completed <br /> u�hether specilied hemin o�noG The,rranfing ol a pennit does nof presume to givc aulhonty fo pERM1T�t <br /> violateorcanceltheprovisionso/anyothersfafeorfocallmvregulatingconsfr�ctionorthe r I �D' ( ! oI � <br /> perlormonce ol%onslrucfion. Thaf I am authonzed by flre omner of(his properiy to pedorm(he t �-� <br /> work for whicfr applicafion is made and!comply with the Sla1e Conlractors Law f8.27 RCW and � <br /> 296 200 WA C. i <br /> �i�r-*�c- C����) l/ - Z - /� ' <br /> � Signa;vre Dale <br />