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ELECTRICAL PERMIT APPLICATION <br /> CIT`f OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-25'-8810 - FAX 425-257-8857 —www.everettwa.org �!— �2 "� � <br /> Ci311� 067 <br /> ���P, l��<aL���U In� �//e�Gt1 . cJJQ• <br /> — , , <br /> PROJECT ADDRESS <br /> QGi-� ,S�P.C��(� y7�6 /l�r�sr���c.3 �(/r'reN ���. <br /> Owner Mail Add�ess Ciry SlatefZip Phone <br /> Tenant Mail ACdress City SlatelZip Phone <br /> Cn�T ���� lr�. o I <br /> P (�wX 173� 5�.�o(,�n1,'SJ, c,.�G. �7��9 / <br /> Electrital ConiraCtor Mail Address City StatelZip Phone i <br /> I �D � 797 oy7 1 `��� ��� i <br /> State License Number Contract Price of Work i <br /> � <br /> j Proposed Use of Building Contact Person (Plan Review) <br /> I <br /> I �Q� <br /> �q;:are Footage Qf residential new consiruclion, remodel or adddion) I <br /> I <br /> Number of devices(I11ow voltage) <br /> Descriplion of Work to �e Done: QdC,� 1:�� $�--� ��r-S l ' / C�U� �C�s �� S�/)1a f4'�5 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �O •Q 6 <br /> I hereby certi/y thal l have read and ex�mined(his applicafion and kno�v fhe same fo be frue and <br /> cormcf All provisions o(la�vs and orcfinances goveming this lype ol work will be completed <br /> whelherspeci/ied hcrcin or noL The granfing o/a pemiif does nof presurne to give autho�iry to PERMIT# <br /> violate or cancel the p�ovisions ol any olher stafe or local/aw regulating construction or the � � � I � � O�� <br /> perfomfance ol consWction. That I am aiRhonzed by the o�vner ol this propeRy b peAomi the <br /> �vork lor which application is made and 1 compty�vith fhe Sfafe Confracfors La�v 18.27 RCW and <br /> 296.200 WAC <br /> a.� "% /i/i�/�� <br /> Signature Date <br /> FEVISFU 12N17 .__ <br />