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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, [VERETT: WA 98201 s..(,� ..� 3 <br />425-257-8810 - FAX 425-257-8857 - ww'w.everettwa.org �'� S��G <br />I <br />''/b / �� �J/�C ��e•/- '�l�� � <br />PROJECT ADDRESS �J!'Yj� ,e%/ GT� C l" �� v" ' <br />� � , ���u,�, <br />- �_�� Fi�� C�L°��,�a�� �, . <br />Owner Mail Address City <br />Tenan� <br />�Jlail Address <br />� L- � �'C �x- �� �> <br />Contractor Mail Address <br />��la���'OC l�%3� ��''7 <br />Siate License Number <br />�r-'����rl /JD �f `�� <br />Proposed Use o( f3uilding <br />/ 5 cl' S �y - �� <br />Square Footage (It residenti• ne�v construdion, remodel or addition) <br />Nuniber of devices (�i low volta�e) <br />L'�escription of';Vork to �e Done: <br />City <br />�.� <br />State/Zip <br />StatelZ�p <br />StalelZip <br />��s <br />�r-=s _ <br />Phone <br />Phone <br />1�� <br />�_'� -/ 39 7 <br />Phone <br />% / Y'LZ�. G�L1 <br />CoNract Price ot Work <br />,.�L�''j�Y�';��"/rT� <br />CoMacl Person (Plan Review) <br />o7Cl �'7l� D/� � <br />�1�! � � � �t� �� i� � 7- � �"r�u� � <br />-��1�{ L`a/� �r�� -���r -�i�,�' �'� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereUy certily fhal 1 have read and examined this application arrd know Ihe same fo be true and <br />wrrecL Fl/I provisions ollaws and ordinances goveming fhis type o/wo�ic �vill be completed <br />�vhether �de�ilied herein ornoL The gianfing of a pemiif does nof presume fo yive aulho�iry to <br />violafe or can�el fhe provisions o/ any olherslete o� �ocal law regulating con�Gucfion or fhe <br />perlormance ^.'consWcfion. That 1 am authonzed by the o�rnero/fhis property to pedonn the <br />n�orh for �.mhich application is made and I comply wifh the Stafe Conhactors Law 18.27 RCW and <br />296.20J W AC. <br />. . . _. o ��aom <br />�i <br />FEE <br />�75�' <br />PERMIT# <br />E130 `�-��`( <br />