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� �_� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G � I S--I S <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org G�S�6 --� � <br /> � o <br /> �524 C��ar�d Rre, <br /> PROJECT ADDRESS <br /> E d Qe�-e.rs�� 15a4- C��rav�� A� ��I� W� RB2ol 425-15� �5 <br /> Owner Mad Address Ciry Slate2ip Anonc <br /> �lA <br /> TenaN Ma�l Addiess Cdy Siale2�p Phone <br /> WP�-crv, Salav `I�i N�me �d S�e � �ell�nul�.rm u� ��Zz� �4��°c��1 <br /> EI¢etneal Coniraetor Mad AdUress Ciry Slate2ip Phone <br /> w�fiEs�g�-z�o 05� � 55 <br /> State License Number(reqwred) Cdy of Everetl Business License Numher(required) <br /> � �J��J <br /> Proposed Use ol Building CoMract Pnce ot Work <br /> Square Footage pf residenlial new wnstroction,remotlel or addihon) Contact PersoNCoNact Number/Emad <br /> Number of tlevices(I(low voltage) <br /> Descnption of Work to E3e Done , I�S`�,�,1( �,f.!/�� r�l,aV Y" ° �5� JTC�{' V 1 _ <br /> FEE <br /> CITV OF EVERETT LOCAL SALES TA)C CJDE IS 1105 �OC.,�.l <br /> I hereby certily fbaf I have read anU examined fhis applicabon and know fhe same fo be fn�e and � _ <br /> ' correct. All provimons ol laws and ord�nances goveming fhis type ol work wdl be comple(ed <br /> whclhcr specified herein or nof The gnnhng o/a pe�mtl does nol presumc fo give authonty to PERMCE N <br /> violate or cancel fhe proviswns o/any ofher sfafe or loca�law regulalmg consf�ucfion or(he <br /> peAortnance o)consUuchon. Thaf 1 am aufhonzed by fha owner o/lhis property fo peAoim fhe E � �O�^ O� <br /> work lor whir.h apphca6qn 5 nradc and I comply wdh fhe Stato Confraclors Law 18.27 RCW antl �V <br /> 296.200 WAC h I . <br /> U ��� �J� <br /> Sign Ua c <br /> ncw;t n anvr.^ou <br />