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�LECTRICAL PERMIT APPLtCAT10N <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.evereNwa.org <br /> 9y�, 3�-� �-,�. �� �o + a <br /> PROJECTADDRESS <br /> 12�o S� £� r�'�r�Ww <br /> So�++�e �a��2. � S�,►� lo� �uene.l�- �.1� 9Fdoy u�;,vs��Pa� <br /> OwnPt AOaI AdGreas CitY StaIMLD Plane <br /> T0f8nt MailAddress Ciry StalrJZip P�one <br /> Ferri+u �leci-r��;Nc Pobo�t 12�68 /n�llCT��c 1,�+� 9���2 4J,I 33753$� <br /> EIECb1WICOnbaCtOf MalAddn,ss C2y StalrlTP PMne <br /> �Q�rl � i 1�7 �� /� U <br /> State License N�imber l:antra Prfce of Worlc <br /> 7p�'! 9-` O — � -e�/\� l-J — <br /> Roposetl Use of BuilAing Contact Person (Plan Review) <br /> Square Footage(If msidential rtew ooMhucba�,mmodel ot addi6m) <br /> Number of devices(I(low voltage) <br /> .Desaiption of Work to Be Done / "�'y ] � V� !?/�l � <br /> FEE <br /> CITY OF EVERETT U`CAL SALES TAX CODE IS 1105 �J�� <br /> I hereby cerlify fhal f have rnad and examined fhis applketion andlorow fhe same to 6e 7fue ai�d V <br /> mrtect M provi.ffons o/faws and adinarwes govem'mg 11ris type ol wak will be compteted � <br /> � whefhers�cified Aereirt or noL 7T�e granRng of a permil does not presume ro give auMonty fa PERMIT# ` <br /> violate orcancel fhe p�ovisions o/any otAer state orlocal law regulating conshuc6on or Me �i �O��� � <br /> perlortnance ol conslrucNon. That 1 am authorized by the ownero/fhis pioperty to peAomr the : <br /> work lor which applica6on is made and 1 comply with fhe Sfate Contracfors Law 18.27 RCW and - <br /> 296.200 C. <br /> c� P� - 3 ,�-1 y <br /> Signeture Date <br /> �nsma�xie� <br /> 2$O$ �$Q0.30��2� <br />