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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 425-257•8857 –�vww.everettwa.org <br /> I(�I�f �.u�1 ��e 5� (^UP�2�C� �S�b�' <br /> PROJECT ADDRESS <br /> t��_V���� rV � �� _ <br /> Ovrner Pda�l Atldress Ciry SlatelZ�p Phonc <br /> Tenanl MailAddress City SlatelZip Phone <br /> ��e�2 �� �a ro�r-�, srsF ���2� �'1- 2�� Yd533o-/(85 <br /> Elcclrica�Contraclor Ma�iAddress City statciz�p Pron> <br /> i �=�,l� �c�,��� ,�33 a (icd f� ��Z3�(5 _ <br /> ISla(2 License Number(�equired) Qty f Everetl �usin s License Number(required) I <br /> ��=E2 -- -- - � <br /> Proposed Use of�uildin9 Contract Price ef Worh <br /> Square Footage(II residential new construclion,remodel or addition) Contact Person!Contacl Num6edEmail <br /> Nurnber ol devices(II low vollage) <br /> c � <br /> Oescription o(VJork lo�e Done� �Ce �� •US<o ����"`�'V� w`�G7 �Se r .� <br /> c f <br /> �/N�4. .� ��`4e �4—_ , (-- _ <br /> F[[ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ���� <br /> I hereby r,erti/}�thal I havc rcad.nd examined(his applicntion�nd knoiv Ihc samrt lo be frue and <br /> conecf. AIf piovisions ollmvs and ordinances governiny fhis(ype ol work�vill bc completed — <br /> �vhether specilied hemin ornoL The gr.nling ol a permit docs nof presurne!o giue aufhoiity to PERhlll�ri � <br /> violafe or cancel the provisions ol any others(ate orlocal lmv regulafing corrs6uction or fhe E �5 0 � - � � -� <br /> pedonnance o!cons(rucfioa Tha(I am aulhonzed by the ownerol fhis propedy lo peAonn Ihe <br /> �rark lor�vhich application is rrmdc and I comply mifh the Stat2 Contraclors Lmv 18.?7 RCW anA <br /> 296.200 WAC. <br /> ��'C�_. l�� 3�l � <br /> Si3naWre Dale <br /> R[b'ISFOOfGE?Oli "_. _ —_ --.----_—' ._ _—" —____ '—_-- '_--_—"- -. J <br />