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ELEC�TRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32G SDAR STREET, EVERETT, WA 98201 <br />425-257-b- 1- FAX 425-257-Sd57 - www everettwa org <br />j�7 �Li (,���� �a�in�, �r��e_5�,��-e l35 <br />PROJECT ADDRESS <br />Owner Mad Atltlress <br />�r�I�(f � �2�( �J M��� <br />Ten2nt �,�tail Address <br />hlail Address <br />YVIs���E�u7NP3 <br />Slate License Number warer$ �d9e <br />f-� �,"c-� .S a �e� Sa �on <br />Proposed Use ot Budding <br />`7Z55��1" <br />Square Poolage Qf residential new conslruction. remodel or addition) <br />Num6er of dewces (II low voilage) <br />City <br />Qty <br />Z�+'.. <br />C�ry <br />Description ol Wor4 to Be Dane' AV� V��G �/`�5 Y J�t <br />�C_�/Q,r _.��2�(lL--�� <"-- -��-- <br />[ <br />--�e ""�-o- --c�-�d ��n'ti.c�`---1�ci,`r � _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />S�a�e2ip <br />State2ip <br />StatelZip <br />a �5-i y <br />[—l��i-/�� <br />�p Z, Oz�-� <br />Contract Price of Work <br />Contacl Person (Plan Review) <br />1 hert�by cerfily fhaf 1 have read and exanrined fhis application and kno�:� fhe sarne to be In�e and <br />conecf. AII pmvisions o/ laws and ordinarces governing lhis fype oI n•ortc will be comple(ed <br />whelher speci(ed hemm ornoL (he gr�nfing ol a pem�if does nof presume lo gice authonty to <br />violate or cancel fhe provisrons of eny olher slate orlocal la�•+ �egufaling r.ansfruclion or the <br />pwfonnance o/construcG i. Thaf I am authonzed by the ou�ner ol fhis property fo peAorm Ihe <br />�vork /or �vhi�j� apphca( ��s made and f c}�rnply �v�Ui the Sta(e Confrdctors Law 18.27 RCW and <br />296 200 ly�C. r �� %% / <br />I arv:sr:: �vcri; <br />L�.-- .— <br />�� <br />. Phon <br />(yz�5a� <br />zo i c� y3 <br />Phone <br />Phone <br />FEE <br />I �ZS o <br />PERh1ITr <br />E (�0� -C�O� <br />