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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES q—i5 i 3 <br />3200 CEDAR STREET, EVERETT, WA 98201 Cc•� i 3ob--�� <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />Z So Y (9 /a�% <br />PROJECT ADDRESS <br />. � ��� S��L �l z gis <br />Owncr tvtail Address <br />Tenanl <br />Eledrical Con�rador <br />S;ate License Number <br />Proposed Use of f3uilding <br />Mail Ildd�ess <br />Man Address <br />9(/F, �I%t/'�ff (U/7L, c/��� <br />GoG� 9�c. t�� �vE/'?tl� �t/fj, Q�"2G� <br />� <br />Cily Slate2ip Phone <br />yG� <br />9[�jrfG <br />Square F�.otage (If residenlial new consiruction, remodel or addition) <br />Cily <br />City <br />SIatMLp <br />Slalc2ip <br />Contract Price of Work <br />Coniacl Pcrson (Plan Review) <br />Phone <br />Phone <br />-- ---- -- (-----9 �. --- -- ---_ . _ -- _ -- --- - --- I <br />Nur.ber of devices If low volla e <br />Lescription of Work to Be Done: <br />� �rC c�-�� ie c� <br />4/ Cc.� ow�E� �i-'�',� i �t <br />wr��o�( oa3 <br />ev�/' ��c.f�%.1� <br />-- � r/.�� - <br />f[E <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 � <br />l hereUy cerldy fhnl I have read and examined lhis anpl�calion and know the same lo be fn�r. and ____ __� <br />conecl. All provisions o/laws and ordinancr.s goveming Uris typr, ol work will be wmple(ed ------ <br />whelher specified hercin or noL The granhng o/ n pwmd docs nol presumc fo gi✓e aufhority (o P[RM1T# <br />violafe o� cancel !De p�avisions vl any other sfale or local law myu/aliny conslruc6on orlhe /� <br />perfonnance o/consiruc(ion ihaf I�m au(f�onzed by fhe ownerolfhis property !o perfonn fhe E i� �(�jQ1p —� <br />work lor whir.h applic�lion is made and ! comply wdh fhe Sfate Conl�acfors Law 78.27 RCW,ind ____ �� __ _____ _ <br />296 200 WAC <br />� 5 fv"�5' <br />---- Signaturr --.. . .---- <br />nr visco �na�� � <br />�• L�'(� <br />'I <br />