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, <br /> 4� <br /> � � <br /> ELECTRICAL PERMIT APPLICATIaN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> _ I 111� �y�f"�1TLL����`�'"` �'`'� a �w� <br /> PROJECT ADDRESS <br /> Owrier Mail Address Ciry StatelZip Phone <br /> �r'�Z.'Z 1�15 ��Fvw i ��� Hl � i <br /> TCnanl Maill,ddress City State/Zip Phone <br /> C T ��yti{��,,�� <br /> 5.;��+�0�5 2i�i� ��E� PL��+I, !!��,� t,�.a 9�1 v�s-�sa- �oo <br /> Electrical Co�tractor Mail Address City State/Zip Phone <br /> �'7'EL EE S C1(o (o /�� � �'�-,�; <br /> Slaie License Nurber Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction,r_model or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to E3e Done: ��'(.�,LI�1C; ` �""� X i"n'fl'S 't"Yt't�+'� � �Z � � U <br /> L. � �-1 l�l- - G` � � <br /> FEE <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 h C)L� <br /> ✓ <br /> I hereby ceitily Ihat I have 2ad and examined tliis applicalion and know the same to be true and <br /> correcL All provrsions u/laws and orrlirrences goveming fhis type o(work will be completed <br /> whelherspecified berein ornot. Tbe granti.ag o/a permit does not presume to give aufhonty to pERMIT# <br /> violato or cancel the provisions oI an��ofhor sfate orlocal law regulating constniction or the � I �� I O � O <br /> per/o�nance of constn�cfion. Thaf 1 am authonzed by the owner o/Ihis pmperty fo peAorm the <br /> work lor which appfi�n is made nd 1 comply with the Sfafe Contractors Law 78.27 RCW and <br /> 296.200 WA�� <br /> // �f/3 <br /> — Signature Date <br /> aeviseo�rzai� <br />