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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �—��"�3 <br /> 425-257-8810 - FAX425-257-8857 -www.everettwa.org E�.�p6_��� <br /> � <br /> �/� �'A.soL /�Ifl�iN�l�e�...�lz' dP� <br /> PROJECT ADDRESS 3(,�•f�'6 7�y(O <br /> �f /�.ss�e.v�� 2o�uy � �i✓o�w�,�� l✓�► 9�'�0 <br /> Owner MailAddress City State/Zip Phone <br /> 1`�iL��,�'�'� ,� ���c��t 1/�.� �'� �„ �,✓A � l��'� ��31.2 :�'3D <br /> Tenant MailAddress City SlalelZip Phone <br /> � �-13oiL � �it <br /> /14�v✓� /.�/.l . J�'l'Y?? sr"a7'1`/-(v/ <br /> Eledric Contractor Mail Address City Slale/Z�p Phone <br /> ,/ � bo �� <br /> �JJ/P�� c'SZD ��, <br /> State icense Number Conir cl Price ot Work <br /> a�X �^ � <br /> �/1� <br /> Propos d Us��uildin� � Contact Person (Plan Review) <br /> Square Footage p(residential new consiruclion,remodel or addition) <br /> Number of devices Qf�ow voll2ge) <br /> Description of Work to Be Done: �`�,�_d u� ��v� �"' � <br />� � .�u.s4 �i9�- �o .?io/� M�'l� S-esnn�-� <br /> �I <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� C' <br /> I hereby certi/y that I have read and examined(his opp(ication and know(he same to 6e fn�e and <br /> correct. All provisions of laws and o�dinances goveming fhis type o(wor',c�vill be complefed <br /> whefherspeci�ed herein or noL Tho granting o(a pennit does not presume fo give aufhonty to PERMIT# <br /> violate orcancel the pmvisions of any otherstate orlocallaw regidating constn�ction or fhe I � (. I <br /> per/ommnce o/construcfion. Thal 1 am authonzed by the o�vnerol fhis property to pedoRn fhe E l �'C�? `" `�f <br /> � work for evhich app/icatron is made ar,d 1 comply wi(h the Sfate Cont�actors Law 78.27 RC W and <br /> 2�6.200 WAC. <br /> �- �/�3 <br /> 5, ,ature Date � <br /> � HE'.:.`:i�n�J:.93 —_ _— — �i <br />