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� � --�— - <br /> ' 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 /> ,� ��l38 6-oS� <br /> ��a 3 ��s �.�� G _, 0--�3 <br /> PROJECTADDRESS <br /> -��,v� Lu�,� �,�,�,5 3aa3 �,ks ��� ,.v�r�-�- .h� <br /> O�vner A1atlAtlCress City £tatelLp Phone <br /> Tenant IdaJ Adtlress Gty StatelZ;p Phone <br /> �Jo��iu.., C�cc4�";� LC� ��?aDJ�� �9(5+ I���te�� (�a �/ko/I �/a5-7io-o7o <br /> EIEUrical COniractOr Mad AdCress City State/Z�p Phone <br /> ,�� �ar-�-�'el �1D3B`� aSva . vc <br /> �tate License Number� Contract Pnce of Work <br /> S�� L�,t ,S lMJTf ,S��^ �-1�$- 7�0-0)0� <br /> Proposed Use o1 6wlding Contact Person (Plan Review) <br /> _ ?Uo �� c�� r c vhc�'e� <br /> Square Pootaye (If residenual new construction, remodel or adAition) <br /> Number ol devices Ql low voltage) I <br /> z <br /> Descrlptwn of Woik lo Be Done: ��' - C�',Y�� � 5 ���-br� �,Q ��oU��. )�5"+" L;�•;ti9 Vno�. <br /> , <br /> , L N�L-. ,{oo '(Y� , GN�� K,�C�'ti l i �l. {-� . <br /> —_ — i <br /> FEE <br /> CITY OF EVERET7 Li7CAL SALES TAX CODE IS 3105 �� d C� <br /> � <br /> I�4ereby cerfdy Ihat I have read and examined fhis applicafion and kno�v the same lo be �rue cnd _ <br /> cunecL AI1 piovisions ollaws and oidmances goveming(his type ol worN wdl be comp!eted <br /> ��•helhcr specrhed hernrn or not. Ihe granting o(a permit does not pmsume to e��e aufhonfy lo PFRM[T# i <br /> violafe oi :anccl Ihe provisions ol any ofher slale or local law�egulaling ronswcfion or the , <br /> perfom�ance ol consfniction. Tlraf I am aufhonzed by(he owner o!tins p�ape�ly to perfortn the E � ?jo � - O 5� i <br /> v�o�ic Ior which app6cafion is made and 1 compty wdh the Staf� Gontrac(ors Law 18.27 RCLY and <br /> :96.200 W1iG. — — <br /> )I i <br /> \I/ I^ �-/v- �3 <br /> ign�ture , - Oale <br /> ( <br /> afc:sco��au ' <br /> -- -- — � I <br />