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ELECTRICAL PERMIT APPLICATION <br /> CITY �F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 30 �� <br /> 425-257-8810 - FAX�925-257-8857 -www.everettwa.org s ' 3 <br /> l8os 2,o c K.e n.F'{,1 l�!Z 2�en.t-i i <br /> PROJECT ADDRESS <br /> � � �,p R,�J /8dsr 2pG {G�'12FG//Cfl <br /> Owner <br /> Mail Address City State/Zip Phone <br /> Tenanl Mail Address City Stale2ip Phone <br /> (.��i R-� � �/902 �9si w�o 5a27s ' <br /> %Jt�q'2 �, s-w Irivk <br /> StalelZi Phone <br /> E�edrical Contractor Mail Address �'�Y �' <br /> nan� � PS9��J��l — <br /> �State License Number Contract Price ot Work <br /> Proposed Use of f3uilding Contacl Person (Plan Review) <br /> Square Footage Qf residenlial new construction, remodel or addilion) <br /> Number of devices(It low vollage) <br /> � <br /> Descriplion af Work to Be Done: /7I T� �ir7 SQ���� I—/'►1��l �'H��� �l <br /> _—_$���i� . � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 /✓ �� <br /> 1 hemby certily that 1 have read and examined this application and kno�v the same to be true and <br /> conecL All provisions o(la�vs and oidinances goveming this fype o(�vork will Ue completed <br /> �vhether specified herein or not The granling o/a pem�if does nof p�rsume fo give authoriiy to pERMIT# <br /> vielafe orcancel the provisions o/miy otherslate orlocalla�ti�regulating consWction orfhe � r ��J _ //_ .� <br /> peilormance ol constn�ction. That I am aufho�ized by fhe o�vner o/fhis properiy to pe�fami the � ( Ki <br /> work(or�;hich applicalion is made and 1 comply wifh lhe Stafe Confractois La�v 78.27 RCW and <br /> 296.200 WFIC. <br /> — 5-. 30 _ ,3 <br /> Si a�e � �n Dale <br /> � RCI;CflJ3.lt�i19 � '___ ___ <br />