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ELECTRICAL PERMIT APpLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98:01 <br /> 425-257-8810 - FAX 425-257-8857 - www everettwa.org <br /> 1/ -35--13 <br /> Ci� ii-I�2 <br /> �12�1 �.�,�4� �- -�,�'R�'t- w� <br /> PROJECTADDRESS <br /> �J-�T��C1_� Lo2��l tJ� 2DZ�'C ��NMOC� u� �� tLY7y� <br /> Owner<_�7}����pN � �,tad Aadress Cdy Slale/Zlp Pqone <br /> DG�Y�1-OF��11T 7�k`t •G1G l <br /> � <br /> nan( 1,1adAddress Ci,y Stale2�p Phone <br /> � OW N�-� �4�y� <br /> ed�+-t�r.�t�1 �„Z�G 1� 2��`'� sr �-�.lt�-��P� w� qP�`�, -49(I � <br /> Electnc I Contractor �.1ad A,dress Gty State2�p P1one I <br /> � <br /> I <br /> State Licanse Number Coniract Price of Work <br /> 5\t�ll�l � '�i`c1..111 Y <br /> Propose Use of dullding Contact Person (Plan Revie�v) <br /> I Square Foolage Q(residenUal new construc6on, remodel or addition) <br /> Number of devices(If low valtage) <br /> IDescnplion of Wark lo Be Done: �N_�C�ION ��R C�NN��O� � ���_ <br /> --- -- --- I <br /> FEE <br /> CITY OF EVERtTT LOCAL SALES TAX CODE IS 3105 ��OD <br /> I hereby certily that I have read and exanuned tbis application and kno�v Ihe same(o be frue:md _ <br /> conecf. All provisions ol laws anU ordinances governing lhis fype o!work�vdl 6e complefed — <br /> v:h�(hc�speci�cU herein ornoL Thc granfing ol a pemuf does not pmsurne to yive aufhonty fo pERMIT, <br /> violafe or cance/�he orov�sions o!any olher sfate or local la�:�mgulating cons6ucfmn or(he E (3l( " f�� <br /> perlammnce ol cons6uc(ion. That!am aufhonzed by fhe owner ollhis propeRy fo peAorm�ne <br /> woik)or whrch applrcaficn is made and I camply wdh the St�(e Confracfors Law 18 27 RCW and <br /> 296200 WqC. / <br /> ���-/�j7`�� �I/ � J/� <br /> S�gnature Date <br /> n���,5c0 t^C�r] <br />