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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 — www everedwa.org <br />yG z y S�P� h r� r�-� �lJ� <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />f.ta�l ACdiess <br />t,lait Address <br />Centrador Na�l Ad,�ess <br />�� azz � . <br />State L�cense Number <br />I-(�� e <br />Proposed Use af Budding <br />z � � <br />Squ�re Footage (If residenhal new conslruclien, remodel or adddion) <br />Number of devices (If low voltage) <br />Gry <br />G;y <br />Slate/Zip <br />Sta1�2�p <br />siacerz�� <br />z3 «� � <br />Contract Price c( Work <br />Conlact Person (Plan Revimv) <br />Description of Work to !ie Done� NQLc� .3� �+^� __ 51Y���__ —` '�U �1�._ <br />c � <br />__—_�a.�t_ — __' � C'C' / _ _ __ `� _ / _.__' —______... __ _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />1 heroby ccifily lhaf 1 have mad and eranrined (his applica(ion and know Ihe same lo he tnie and <br />correc7. All p�vvisions olla�vs anA ordinances goveming this type ol �vork will be complereA <br />�t�he(herspecdicd hercin orneL Thc yianfing ol a penni( dor.s nat presume lo �ive iulhonty fo <br />violate or cancel tbe piovisions o/any o�hersta(e orlocol la�v regulaling constn�chon orlhe <br />pedannance o/cons(rucfion. Thal l arn au(haized by Ihe o�vner ollhis pmperty to peAonn the <br />n•ork lor �rhich application is made and I comply �rAh fhe State Cont2cfors L aw 18.27 RCW and <br />?96.200 N'AC. <br />�? -- — —L�- 9- i3 -- <br />Signa;urc Date <br />R! C�SEU 1?p'13 <br />Phcne <br />Phone <br />360 <br />Phonu <br />FEE <br />12O°° <br />P[RPiIT� <br />Ej3�0-o��- <br />