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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857—www.everettwa.org <br />'�-'11"1 l��t��s�c�l /�v'� <br />PROJECT ADDRESS <br />`z3-�s `� t{ <br />� i yo�'—�:��j <br />��;iilG �02C1 �e1.a`6 �D�` � IJ� ��1Q�(SJ�\l�` Wn 9`b�L—LD <br />Owner MailAdAreSs Cily SWte(Zip Phone <br />Tenant <br />Mail AdAmss <br />City <br />SlateQip P�one <br />GA¢�l�u Ll�czz.� <br />Eledncal Cor,iredor Mail Address CMy Sta�e2ip P�ane <br />Stale License Number <br />SlN4LF Tq.M��`i <br />Proposed Use ot8udding <br />$5� <br />Square Footage (I( residentiai new construdion, remodel or adaition) <br />Number of devixs (If �ow voltage) <br />Contrad Price of Work <br />Contact Person (Plan Review) <br />Descnplion of Work lo Be Done: l_.,J M PI-z'�2 1lC — W i 2e r1 �� £ `J'-r �' ��''� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />1 hereby certily fhnf I havo road and eramined Ihis applir.elion and krrow Ihe same fo bo trvo and <br />rorrecf. All provisions o/ laws anA oNmances goveminy Ibis typo nl wodc will be complr.leA <br />whetbcr spcci6oAhercin oi noL lhe granliny ol a permit docs nof pmsumc to ,qive aulhonty to <br />violate oi cmicr. � fhe provisions ol any ofhr.r sfnfe orlocal law re,qulalin,q cnnslmcfion or Ihe <br />peAormance ol constniclion. Thaf 1 am aufhorized 6y the owner ollhis property (o pr.Aorm ff�e <br />work !or which opplicofion is madc nnA 1 comply wifh fhc Sfafe Contmctors Lnw 18.27 RCW and <br />296200 NAC. <br />Sgnalure Dale <br />HMS!'� 3T(V�] <br />FEE <br />75 �� <br />PERMIT# <br />E (y Dg- 12 <br />