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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT 5ERVILES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org � �_ � �� �� <br /> ��� �� �I y� <br /> �1�1 L,u���,�e. �4�.�e_ <br /> PROJECT ADDRESS <br /> D�'Y! r� i4ccz�2 i� / 3o Z- /OU ^'G!T 6E �vueGt Gr/�9 7���8 <br /> Owner A1aA Address Qty State/1ip Pnone <br /> Tenanl A1aa Address Gry SialclAp Phone <br /> �ltu� �. �i� „�rt[ ( ��7�/3_�,✓s.�2d �' �,.��w<<S W14S��32 (36o)S2.F/sI <br /> EIeCInCaI Conlr�cior Atail Address Cdy �IaleR�p P�one <br /> V����s�a�- as� 6/9 <br /> State License Number(required) Ciry of Everett Busmess License Number(rcyuired) <br /> sF� `�3 oatl� <br /> Proposed Use of f3udding 5n1�t�Pnc��r�� <br /> � <br /> �oo ✓r v,o��c, sw��G�co,l. <br /> Square Foolage (II resitlenlial new conslrucbon,mmodel or addihon) Conlact Person/Contact NumbedEmaA <br /> Numbcr ol devices(Il low voltage) <br /> Descnplion ol Work lo Be Done: J Pil`�l�(L e— ('i�^QM. C . {�j� 4���/ Y��y O GV✓/G e <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 750� <br /> I here6y ceRlty fhal I Nave�ead anA exanuned Ihrs applicafion anA knowlhe sarne fo be true and <br /> correcf. All pmv�sions ollaws and ordinances yovemrng this type of wo�k will be cornplefed <br /> whether spcc�feAhereln or not The granfmg o!a permil does nol presume to grve awhonty�o PERMIT# <br /> vrolafe or cai�ce!the provisions of any ofher s(a�e or local law regWa6ng construction or fhe �I 1 ' I I , I I r � <br /> peAormance �(construction. Thaf I am aufhonzr.d by fhe owner ol Ihis property fo peAomi Ihe 4 � 4 <br /> work for whicb applicafion is made and 1 comply with tbe Sfafe Confrac(ors Law 1827 RCW and <br /> 296.20,0,WA C. <br /> /JCa�_ �-- �/ /7 /� <br /> SignaWre Dale <br /> RNISEOOSDNd01� <br />