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ELECTRICAL PERMIT APPLICA'TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 3 � �_�s <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> � �Sn 3-�q � <br /> q ��g <br /> � C� � o SS I S� D r S E ���,-��(�- , w A � ����g,_ <br /> PROJECT ADDRESS <br /> � o � ��� �� I� � 13oX � ZZOS /L1��� C+'cc� W� 9 ���Z '�255�1- o9G <br /> Owner MailAddress City State2ip Phone <br /> Tenanl Ma�l Address Cily StatelLp Phonc <br /> 42s <br /> ���s-F't �l ��ec-�i'1� �35�� `( 3'�` �r S� s�o�la,�.�r� Il�l� `Ib'7YG 2�P �s9 / <br /> leclriral Conlrac�or Mail Address Ciry Slatc/71p Phonc I <br /> �US� ,' � ��� � � �� 06 3� � <br /> State License Number(required) Ciry ol Everett Business License Number(required) <br /> 00 <br /> �-c5 - /zao. <br /> � Pr posed Use ol Building Canlrar,l Price ot Work J <br /> �1zr sb <br /> �/I l� S� �F t �l� �o � <br /> Square Footage( residenlial new construclion, remodel or addihon) Co act Person/Contact Numbed[mad�--- <br /> Number ol devices(�voltage) � <br /> c� � v�", ,� � ��I <br /> Descriplion ol Work lo Be Done: / G/1L/ C�� �" ����7 -r'A�DdP/ ��� �/�/ <br /> —f----- <br /> �Ot��C� -- — <br /> FEE <br /> CITY OF EVERETT I.00AL SALES TAX CODE IS 3105 75�� <br /> 1 hereby certdy(huf 1 have rcad and exarr�ined fhis applicalion and kno�v fhc samc!o be fn�c anU __ <br /> comct. All p/avisions ol la�vs and ordnances governing ILis type ol work will be cornpleled ----- <br /> whethc�specilicd hercin o�not. T lro granting ol a pemri(docs not presumr. to 9ive au(honly fo P[RMIT7! <br /> v�olatr, or canccl lhc prov�sions o(ar thcr slafc or localla�v regula(ing consfruc(ion or Ihc � <br /> perfomcance o/conshucfion. �a n ufhori:ed by Ihe owncr ol(his propcAy(o pcAonn Ihe I�O 3 _ D�O <br /> wo�f<lor which a c ion � � �r comply wilh Ihe Sfatc C nlrnclors La�v I827 RCW and _________ <br /> 296.200 W . f� /�/ p <br /> �,��"G��� �O Z C7/S� <br /> � - -- - - -� - <br /> Signature ����" <br /> nr-ws�n narnwn i a <br />