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( - — - _ _ _ _ _ <br /> I <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEOAR STREET, EV6RETT, WA 98201 <br /> 425-257-8810 - FAX 47_5-257-8857 -wv✓w.everettwa.org � <br /> n�- as -� � <br /> C � � o ��� z <br /> � C�UZ.--L ��k�� <br /> PROJECT ADDRESS <br /> �,�, 3Lv�erSc� �vz �...�I� � ��v e r�'[l` _L��f�iJ_ <br /> Gv;ner AtanACCress C�ty Slale/l�p Phcne <br /> � <br /> ITenant b�alAdaress C�;y Slale2ip Pnene <br /> e� __��r��l��?_t���-��,�-�- ��z�=3- I <br /> -IeclricalCont ctor Mad�ddres Gy staieiLp Phcre <br /> I -�v�(_,S D-� O� � -- <br /> State Liren,e Numbc-r Ceniract Price ol Wo�k <br /> Propos d Use of Ewiding Contatl Person (Plan Review) <br /> Square Foofage Qf residential,iew conslruction,remodel er addition) <br /> Nunibcr of devices(If low vol�age) <br /> Desaiptiun ol1'Vmk lo �e Done� �_�'}'Vt�_._�J� �1/ �.v �"��1$ 4f1N�tLt��_—_ <br /> � C Ur'T°�-'� — ---- — — <br /> — -!t».'-- -- - — <br /> FE[ <br /> CITY OF EVERETT LOCAL SALES TA7( COD[IS J105 �Ow <br /> I herehy ceriily fha(I have read and exan�ined(his applicafion and kno�•�Ihe s:,me fo be hue:md __ _ - -_ <br /> correct. All provisions ollaws and ardinances goveming this type ol�vo�k��vdl br, complefeJ ---- -- --- <br /> :vhelher specdin.d hcrein or nol. Thc granling ol a permrt does nol pmsume(o give aulho�ity fo PERhif�tl � <br /> vielaleorcanceltheprovisionsolanyofberslaleerlocallawregulalingconsfrucfionorlhe r I� ,1 ry_I �� <br /> pedormance oI r.onslruction. ihat 1 am aulhonzrd by fhr, o�rnei ollhis properfy lo peAonn!he C U �� <br /> work lor�vhith applicafron is made and 1 c�mply�v�lh(he Slafe Confraclors La�v 18.27 RCW and <br /> 29G.200 WAC. <br /> --����``f��—� ---��L��y- - - <br /> Sionature /7 a�' <br /> V <br />