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ELECTRICAL P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT', WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org 5_�3��� <br /> C�3o��► � <br /> �� � �G�4��'. � i �'-v� I ,� �v �{� _ <br /> PROJECT ADDRESS /q a Cq� <br /> , R�� / �� 7� �� � S`�(� C��L <br /> � ��i,J � -�r:� , � V�L6iC.lil � "V � �'1 �1i�� T. � <br /> Owner Mail Address City Slate2ip Phone <br /> Tenant Mail Address Ciry SlatelZip Phone <br /> C.�P`f e� �ZS <br /> , �a7 � 7 ��/ �� -,-� .���� 6 S <br /> ���r-�_�'r'_� �rL�r�G....� �c:.Y'�� i c r- L.l-L f� V- L,! W � ��C � Phon� <br /> Electrical Conlractor Mail Address Ciry SlalelZip <br /> �TC��GS ( � I rJ �> �'/ ��c,^ r- <br /> Slate License Number Conlract Price of Work <br /> ��u �`� �'b1 � (��I ��-•t1� ��`��/. <br /> Proposed e of Buflding� Contact Person (Plan Review) <br /> Square Foo�age(If residential new consiruction, remodel or addition) <br /> Number of devices Qf low voltage) <br /> /� � <br /> � f. / <br /> Description of Work to Be Done: ���ti'n �G 61 Wl ��L��t✓� �'`' / �'���`'� �n�` "` °T"� <br /> i <br /> , FEE <br /> II CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ?�j. G1 U <br /> i <br /> I I hereUy cerii(y fhat 1 have read and examined this application and kno�v the sarne fo be tn�e and <br /> � correcL All provisions of laws and orrlinances goveming this fype o(�vork�vill be completed <br /> �rhetherspecilied heiern ornoL The granting o/a pemiit does nof presunte lo give autfwnty to PERMIT# <br /> violafe or cancel lhe provisions ol any ofhersfate orlocalla�v regula(ing consWction or the <br /> pedom�ance olconstruc(ion. That I am aufhonzed by fhe o�vnerol(his property fo peAomi fhe E I 7�/1; � C%�, <br /> work tor which application is made and 1 comply wilh the Stafe Conlractors La�v 18.27 RCW and <br /> 296.200 WAC. <br /> I � ' � �J��� <br /> ���� Y��c <br /> : SignaWre Date <br /> � �:.���.-�_-; r, ... ---- — <br />