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ELECTRICAL PERNlIT APPLICATION <br /> CIT'Y OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, WA 98201 5 � ab " �� <br /> 425-257•8810 - FAX 425-257-8857 -wv✓w.everettv+a.org <br /> G—IyoS �117 <br /> �7Z� 1..)eSl �j',�2 ��e�e�t� �a q��°'S <br /> PROJECT ADDRESS <br /> J- � C�` <br /> k'li �¢.w✓ �j7L5 Wey �!;✓Q Cve/e �a �t$u'3 �{25-47`S•o 6 <br /> Ownef tdaJAddrew City Slale2ip Phone <br /> Tenan� AtailACdress GIy State2ip Phcne <br /> ` L 57i 5 b6N, J��e 1�E �/, I �z5��-Ss 1( <br /> GfJ�.�c� �lv�cl�-C.. I'�°i�5�:1,P G.�a �{�-70 <br /> � <br /> El2ciricalCoMractcr h7aJAddress City Stale2p Phone <br /> `��a;�ce l�l O�t2. — <br /> Slale License Number Conlract Price of Work <br /> ��;ao^�:�,� <br /> Proposed Use of Building Contad Person (Plan Review) <br />� Square Footage Qf residential new construclion,remodel or addilion) <br /> Number ot devices(Il lova voltage) <br /> �escriplion of Work to Be Done: r`�� �w`�"�� �`+ C�/C�-� C�t I�`�cJ°"X'Je- <br /> - ---- � <br /> FEE <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 y-� n� <br /> ' �/ lJ <br /> I hereby cerlily Ihat I have read and examined this application and kno�v lim same fo be frue and <br /> conect. A/l provisions o(laws and ordinances govemrng Ihis type ol worN will be complefed <br /> wh=lher speci(ied hernin or nof. The g�anfing ola permit does no(presume to give aulhonty to P[R�+IIT�J <br /> violateorcancel�heprovisionsolanyofherslafeorlocallawiegulafingconsWc(ionorlhe � r��-��� <br /> performance ol consWction. Thaf I arn au(honzed by!be owner ol fhis propeRy(o p_dorm Ihe ��0�� �'�� '7 <br /> �vork for which applicafion is made and 1 compry wilh the Sfafe Conlractors Law 18.27 RC W and <br /> 296.200 WAC. <br /> � Z�� ��� <br /> 5- <br /> S' ature Date <br />