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3S1 �ZO — P�21 MON i (1 PQ.'f MEr�'f • <br /> � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDF,R STREET, EVERETT, WA 98201 <br /> 425-257-6810 - FAX 425-257-8857 —www.everettwa.org <br /> Clv`�o9 -f47 <br /> . �� 3 _�,� <br /> I Zl1 ��I��C AUC-.• ��crt�� r w�. �i8a0� <br /> PROJECT ADDRESS <br /> �ReQLL E�a� za(�-zzl�-3zo - <br /> Owner Mail Address Cdy Slate2ip Phone <br /> o�,;� �q2"�mEa7S ILtI �ActC1C R�L ��2ETr wn 9�aoi <br /> TenaM MaJ AtlCress Cny State2�p Phone <br /> �a�„ CAa��Nh iAi�uc-�Fn �vE ��zo ��EeE� wp.9bao � �ns-a�a_Bzs9 <br /> Eleclrical Contractor Mail Address C�ty Sta�e2�p Pnone <br /> �Q-�oc79 yy DO U 5,��S <br /> State License Number(reqwred) City of Everett Business License Number(required) <br /> ; }gob.00 __ <br /> Proposea Use of Building Contract Price ol Work � <br /> a�N wo�cc ti2S-2q9 -4G4� __ <br /> Square Footage(I(residential new construclion, remodel or addition) Conlad PersonlContact NumberlEmail <br /> 31 <br /> Number o(devices(If low vollage) <br /> Descnplion o(Work to Be Done: i��u A 7iar� c��" �2E ALA2�M SVS�� <br /> fEE O <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS J105 �[�21� O / <br /> '9\ <br /> 1 hereby certily that I have read and ezamined this applicafion an�know fhe same to be We and � _ <br /> correc(. All provisions ollaws anAordmances goveming fhls type oI worh wdf be completed <br /> wbether spedfied herein or noL The granling o/a permR does nof presume to give a�dhonty(o PERMiT# <br /> violate or cancel fhe provisions ol any o�her stafe or local!aw regulafing consfrucfion or the r I��/�� ��/� <br /> C v� ( <br /> pedomiance o/constnrcfion. That 12m au(honzed by(he owner ol fhis p�operty to perfomi fhe � <br /> work lor whicli applicafion is made and 1 comply wifh the Sfafe Confractors Law 18.27 RCW and <br /> 296 200 WAC <br /> >- 3 -!s <br /> � Signature� Date <br /> REvls[0 o8N6?01a _ <br />