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E�ECTRICAL PERMIT APPLICATION <br /> CITY OF E!'cRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857 —www.everetlwa.org <br /> /�JZ � �'r�r7a ,�(/L ��.�✓� <br /> PROJECT ADDRESS <br /> ,L��G/ �/G�.l Y'1��J�l�l'eil� ��^-� a�/ �'✓�a-QU-c_, _ <br /> Owner � Mai Address City State/Zip Phone <br /> Tenant MailAddress Ciry Slate/Zip Phone <br /> L� (�r���/�i �2 �D �� 2D2�f ��,a-�'�.-�-�il I,Jl�I- ��d�(l <br /> Elec�fiCal Conlraclor MailAddress Ciry State/Zip Phone <br /> C-�CQC�S�I,�'s�r= � 60� <br /> State cense Number Coniract Price of Work <br /> -�Vvd� <br /> I Proposed Use of Building Conlacl Person (Plan Review) <br /> 9a� <br /> Square Footage(If residential new construclion,remodel or addilion) <br /> Number of devices(If low voltage) <br /> I Descri tion o(Work lo Be Done: �""- �� � <br /> P <br /> ' FEE <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 `" <br /> I hereby certi(y that I have read and examined(his application and know the sarne to be We and <br /> � � "�)Ll <br /> conecL All provisions of/a�vs and ordinances govcming fhis type ol work�vill Ge completed <br /> �vhetherspeciTed herein ornoL The grantir,g o!a permit does nol presume to give autho�ty fo PERMIT# <br /> violate orcancel the previsions o/any other s(ale orlocal law regulating canstniclion or fhe —7 /� I <br /> pedomiance ol constn�ction. That 1 mn authonzed by the owner o/this property fo peAomr fhe E � >C;'l � V� S�+ <br /> �vork lor�thich applicafion is mado and on��th fhe S�afe Contractors La�v 78.27 RCW and <br /> 290.20 C. <br /> �� `�� / <br /> ' L-c `� _� . - 1��3 <br /> � Si9nature Dat <br /> rr:,r=c a:vi3 <br />