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� � <br /> ELECTRICAL PERMIT' APPLYCAT�C�iV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 5 _ Q _�� <br /> 425-257-8810 - FAX 425-257-8857 -v✓ww.everettwa.org C w I u ps`d�3 <br /> \`��b� ��� oMi � �I �-.F W �- �a �m� <br /> PROJECTAD�RESS <br /> � <br /> L� �� �u- ����s �,. � ��;.� . ��, w/>- ��I f�2r �� <br /> Ovmer MailAddress City �,,,,,-}-�� Slale/Zip Phone � � <br /> Uw-'^"'� <br /> Tenant Mail/lddress Cdy SlatelZip Phone <br /> � `� -S ��a..c-�- ��45�4 ��t'1 h �r^'S �'.2�— �J El- `'1z�o'3� <br /> EledriwlContraclor A1ailAddress Cdy Stale2ip Phone <br /> C`V S ��- �A�.� � Dd '� Zbbo , u v <br /> Stale License Number Contracl Price o1 Woik <br /> Proposed Use of�uilding Conlact Person (Plan Review) <br /> Square Foolage Q(residential nev+conslruclic n, remodel or addilion) <br /> Number of devices (II low voltage) <br /> c � <br /> ,=y_���� �.o a_ �� $`.e�w r Gt� �,� <br /> Desciiplion ol Work to �e Done: --— <br /> ���. <br /> FEE <br /> CITY OF EVERETT LOCAL SAI.ES TAX CODE IS 9105 �)5 O� <br /> l <br /> !hcreby cerlify fhaf 1 havc read and examinedlhis applir,afion and knov�thr. sarne to bc trur, and <br /> conecL All provisions ollaws and o�dinancr.s goveming(his type ol work w+ll be compleled <br /> whefher specilied hcrcin or noL !he granfin�ol a pennil does nof pres�mie(o give aufhonty(o p[RMCI lt <br /> vrolafr, or r.ancel fhe provisions o/�ny ofher s(�ifr. orlocal!aw�egulafing consfn�cfion or fhe <br /> performance olcanslnic(ion. Thaf 1 am aulhonzed by tlie owner ol U�is prope�ty fo perform Ihe E w ' �D�— 0D3 <br /> work/or which app6cafion is rnadc and 1 comply wdh Ihc Sfale Confracfors l.aw ;d.27 RCW anJ _ <br /> 29G200 WAC. <br /> ��r�-.,�.i ���7-d �� <br /> �_ - <br /> Sianalurc Uale <br />