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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9&201 5`� �'�t � <br /> 425-257-8810 - FAX 4'LS-257-8857—www.everettwa.org <br /> � � UDS"�d� <br /> a7 � a Co��y � Su ��� �. vo <br /> PROJECT ADDRESS <br /> Owner Mail AdCress Cily StafelZip Phone <br /> s�N�1�01'VIIS 1{ COuI�/i Y Pw4'�tL 1�/t3Fi=Ndl`� <br /> Tenanl/1 Mail Address Ciry State/Zip Phone <br /> �ul1nL l.,l.�`C j/elC ��.�s�JS?•t7rl � <br /> 3yv� M��ouU��« /��� ���,��i�- wr� 9s�o , <br /> EleclricalConlfaclor MailAddress Cdy State/Zip Phone <br /> /�.MN�EEI °I�,GQiU � J � OUD. DU <br /> State License Number Contracl Price of Work <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Square Footage (If residenUal new conslruclion, wmode�or addilion) <br /> � Number of devices (II low vollaae) <br /> i <br /> Description of Work to 8c Uone: �ENA N T I N�{AiCDUEi!l��tJT' fJ(= SE�J�✓✓J hCpOh2 __ <br /> G�F(LCS ` JpEMO✓� G✓ACIs AN✓J /�dd N��✓ RECtPlNG.r.'S <br /> FL=L <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 ��� � <br /> I bcrehy ccrLly fhaf 1 h,�vc read antl examined Uiis applicalion anA know fhe same lo be Inic and <br /> conrct All prz�visians o/lows.+nd ortlinances yaveminr�Ilris type o/work will Ge complefed --- <br /> �vhcfhcr specr�ed bcrcin ornoL Thc grunGng ol a pem�if dacs nof presume to grve airthority lo pFRMITa! <br /> viola(e or r.ancel(he provisions of any ofher sfate or IocaUaw n;gulafing wnshucGon or fhe � / <br /> pmfonn:mcr. o/%onsfn�r,lion. lhnf I arn aulhonmd by fhe nwnero/this properry(o pr,�fonn;hr. E / �O�— � /1/J <br /> wo�k!or which npplicnfion is madc and 1 corrrpty wifh fhc Sf.+(e Confr,�cfors Law 18.27 RCW anJ __ `�� <br /> z�e.z nc. � ;-_ �.'�`"• � `� li <br /> �, a <br /> Si9nalure � � � Date <br /> Rrvr,cn.vidn I <br />