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ELECTRiCAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREGT, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www everettwa.org <br /> 3 - �-/� <br /> �ryo3�-�� U <br /> �3 Sa� �� ee-•�. �e.� � ��S/ <br /> PROJECT ADDRE <br /> � r�-��N 3z oo Ga,�.s'�- y�z�e�_�/� 9�z o/ <br /> Owner �dad Address CAy Slalcl2ip Phone <br /> �L.n t ct S— `l�J�srt — <br /> I Tenant fdad ACdress C�ty State2ip Phone <br /> � �s-� - own�+' i <br /> [lectrical ConlractOr I.1a�l Address Cdy State2�p Phune <br /> I �rYJ.¢/G L�JL 9/ 8'�G- /sp� �.-- <br /> jState License Number Contracl Price ol Wprk <br /> ,�¢,✓ oi f-r;�� �'Y�7�'.e�—. l�yv�' �'e��i�c. � <br /> Pioposed Use of Qudding Contacl Person (Plan Rev�evq <br /> �a,s�� �p �`i`" � <br /> Square Footage (II resident�al new conslruchon, remodel or addi6on) <br /> Number ot devices (If low vollage) <br /> IDescriplion o(Work lo�e Done� �{,�� /�,ei,✓ �'GiL,� //;..,,s.�efiu� G!�'zc.�iY� <br /> � _ � _rr� `+`� ���_�.�%��—_. - - — - <br /> � -- — <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 I G� � rJ� <br /> I hemby cerhly that I have read and examired Ihis applica6on and know the same fo be hue and I <br /> coRec(. 1111 provisions ollaws and ordmances goveming fh�s type ol woM will be compleled <br /> wheU�r.r specfied heiein or noL rhe gnnling ol a pemiif does nof presume(o give authonry lo PERh1Cf x <br /> vio!ate or cancel the provisions ol any ofher sfate or local law mgulating cons(ruction or the ^ I , 1 D � ' I,�I , t <br /> pedormance ol conslmcfion Thaf 1 am nuthonzed by fhe owner ol fhis property to pedorm Ihe t � v L� <br /> �vort.lur which appLcafion is made and 1 comply wrlh 1he Sfafe Confncfors Law 78 27 RCW ar.d <br /> ?96.200 WAC <br /> �y�-����� .� - y- � �i <br /> S�gnature Date <br /> tiFt 5'p3iG�i3 <br />