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ELECTRICAL PERMIT 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 <br /> �c?c�s ��.�k- S �r <br /> PROJECTADDRESS <br /> �KFG�C. L47.c� Z-37S 1,3p��4•it /L� /3P�(Cv_uP !� �/fScx�S ' <br /> Owner MailAddress City Slate2ip Pnone <br /> Tena�l MailAddress City Slate2ip .Phone <br /> (3�0) <br /> LJ �-�- EIP�� ��� 7�,�. - _ ot36 �4 - G,-A,,,� e f-ails - -G�s25z- �s4-ero+i <br /> Elecirira Contraclor Mail Address Ciry SlalelZip Phone <br /> WYA�'TE7=�1�5'PD 05 'i - 2z�- <br /> State License Number(required) City ot Everett Business License Number(required) <br /> �7r� c�cv <br /> � t� <br /> �00. �— <br /> Proposed Use of Building Conlract Price of Work <br /> ���r� � ��..�`dW G`ir 'fzS87vS <br /> Square Foolag (It residential new construchon,remodel or adddion) Contad Pers nlCo�nt/acl N/umbed ad <br /> !(.�Vv�G v'C cv'�c��y-wi/,.�•� .'h <br /> / <br /> Number of devices (If low vollage) <br /> JJ2� ��� ��P �G 64*�+A S ' �-��•��//_. , . �, <br /> Description of Work to Be Done: `�-- <br /> � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 /D QO <br /> v� <br /> I here6y ceRily that 1 have read and examined this applicafion and know�h�same to be frue and <br /> � <br /> torrec(. All provisions ollaws and ordinances goveming this type olwc ,:�•ill be completed <br /> whether specified horein or noL The granling o!a pemiif does not presume fo give authonry to PERMIT�I <br /> violale or cancel the provisions o/any other stafe or local law�egulefing consfruction or the � � r,J r� D� � <br /> peAormance o/conshucfion. That 1 am authorized by the owner of this properiy to peAorm the `C <br /> �vork lor which applica ' s made and I comply wifh fhe Stafe Confracfors Law 1827 RCW and <br /> 296.200 WAC. <br /> /'l` � l � -l.(.e ' 1�{ <br /> /Signalurc �a�e <br /> � <br /> FEVISED 049V10I1 i <br />