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--- -- - --�. — � ---1 <br /> ELE�TRICAL PERMIT APPLIC�4TIOtV <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 /> G - 3-�3 , / <br /> � � l7 {f ? �,J 'I.�,�, � 1306--av'1 <br /> PROJECT ADDRESS <br /> �Lc�h � )�G-^�' i 5�•"�� ,�;�.- . !'N�a�c _ <br /> Owner � Matl�ddress Gly StalelZ�p Phone <br /> Tenanl MatlAdtlress ' Ciry StatelLr Phone <br /> s"(oo - 6 1 r <br /> c;J�s-rr� :���� �cc �9�� � ,v� r'i�-�✓i�ce w.�+. -i�X'Z?o � zo� <br /> GleclricalConhactor tdadA�Cress Gty Slate�Zip Phone <br /> r <br /> (/�vS'i/!' C �/7(� �L I �!�! <br /> State License Number Conlract Price of Work <br /> s Ff� <br /> Proposed Use o(Bwld�ng Con�act Person (Plan Review) <br /> i <br /> Square Foolage Qf residential new construclion,remodel or additlon) <br /> Number of devices Qf low vollage) I <br /> Description ol Work lo Be Done�. �b f/Pu���4'C��-��^� `� a^�- �'r ��''�"���0�� OwT��'� <br /> FE[ <br /> CILY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��� <br /> I hereGy certdy that 1 have read and examined fh�s applica(ion and kno�v the same fo bc 6ue and _ <br /> correcL All provisions o/laws and ordinances goveming Ihis(ype ol�a�ork wdl be compleled <br /> rvhether specified herein or noL Tbe granling ol a permd does not presume fo give au!hoiity(o PERMII;! <br /> viola(e or cancel(he provisions ol any ofher state or local la�v regulabng cons(rvchon or fhe E � 3 0 ( - OU�- <br /> perionnance ol constniction. That 1 am aufhonzed by the o�vner ol th�s pr�periy fo pe�/onn fhe <br /> evork lor u�hrch applicalion Is made and 1 compl��vdh fhe Slate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ,4�/� 6 -j - /� <br /> - �anaiure oate <br /> ac usco.i:ac <br />