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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 />I/�N��'S ��(Z i14t��tu,ti�s•� <br />PROJECTADDRESS <br />6-ia�i� <br />Ei3o6—o(,� <br />��nlq �� � ���an�z DNrus r�ir�z P Nch�rs+ �� �u�rc�N 4Sc �8'�0.5 <br />Ownef Mail Address City StatelZip Phone <br />Tenanl <br />Mail Address <br />Ciry <br />State/Zip Phone <br />a�� a9� �3�y <br />LDT E(�c3r� �L� I�U�-,a� l73� J�C�cn��5� Gv�•95�7`r! <br />Eleclrical Conlracto� Mail Address City Slate2ip Phone <br />bo� I�t7 cy� <br />Slale License Number <br />sr-� <br />Proposed Use ot Building <br />Square Footage Qf residential new conslruction, remodel or addition) <br />Number of devices (If low voltage) <br />Contrac�ice oi Work <br />(� �, � -� �: %c //e� <br />Contact Person (Plan Review) <br />Description of Work to Be Done: �c'��! __�� Y�, � >>== il ��GAr�: �� ti� 1 �7n1J reai; r 5 <br />/�c{lrc� 5��h;��c! ��u l--a,-�r�+c� /oG /li�',� <br />� <br />l'I,u��j� � cv� l�;I�aS <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily fhaf I have read and examined this application and know fhe same ta be fn�e and <br />conLcf. All provisia�s o(laws and ordinmices goveming (his type oI work will be completed <br />�vhether speci(ed herein or not The granfing o/ a pemiit does not presurne to give aufhonty to <br />violate or cancel the provisions of any ofherslate orlocallau� regulafing consWction orthe <br />performance o/consWction. Tl�af 1 am authoiized by Ihe ownerol this property to pedonn (he <br />work lor which applicalion is made and 1 comply wifh lhe Sfafe Contractors Law 18.27 RCW and <br />296.200 WAC. <br />i+emseo v.�aia <br />FEE <br />_Z� n o <br />PERMIT# <br />E 130��- a��' <br />