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� - --- -- - - - --- - - -- ----- � <br /> i <br /> ELECTRICAL PERMIT APPLICATION <br /> ; CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 —www everethva org I <br /> �Z --/���� <br /> C 13/Z-�� Z <br /> r 21 q nv�k-er- ,�.�c.. �,�-e-�1- �,� .� �R zc� � <br /> PROJECT ADDRESS <br /> 5�,,, p�y1�C.�-� — �haV(. — <br /> Owner Mad AdCress C�ry State2p Plmne <br /> Tenanl 1.1ai1 Adoress Gry SIatMZ�p Pnone <br /> ���r,yF Roo��nti4 .<o��:.�I,IC� 'L?�70� �i'' � SE SFc. L ��C(� �J� °IF:�"L� <br /> EleCiriC21 CoMraClor ldad Address C�ty State�iip Phone <br /> 1=o�E,�.��53�30C.� �2(c,boo <br /> ISlale License Number Con,ract Price of VJork <br /> i <br /> . F� ��--°���—�sby- I <br /> Pr000sed Use of Buildiny Contact Person (Plan Re'vie�� <br /> Square Fnolage(It residential new construclion, mmodel or add�tion) � <br /> fJumber ot devices(If low voltagc) <br /> Descriplion o(Work lo Be Done�. �n y�'�, ����Cr^ pr� F��"'�' roa�� S��nMsl� �h • �t'+t _ <br /> ;� i ��k��o� � .,i�s____p�a�7 a�� fxo M'L':'i.1�'u'�._s. �1�'Ln" I ,, <br /> -{Ti rna,-� �.7�Y ------ — <br /> FEE �O�� ---- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cmiily thaf 1 have read and exanrined this applica(ion and kno�v the smne lo Ge Inie and ______ _ <br /> co�ecl All provisions ol la�vs anJ ortlirrances 9oveming this type n!�rork wdf he complefed <br /> whe0ier specificd hercin or not. The granfing o/a permit does nof presume to give aulhonty fo PERh1IT# <br /> vio/ale orcancel(he p�nvisions ol any othersfafe orlocal law mgulating constvclion or(iie <br /> peAonnance ol cons(ivc;.an. Thaf I am aulhonzed by Ihe owner ollhis propeRy fo perform the E I � 1'l ��� Z <br /> �vork lor which appOcalion is made and 1 comp, �wlh Ihe State Con(racfors I.a�v i9 27 RCW and �L <br /> 296.200 WAC. <br /> �/Y-��/-���' �In. I 2' I�- I'� <br /> �T:qfalUK/ � �� Date <br /> FGNS°D 1:4'1] � � <br />