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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SF_RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www everettwa.org <br />3 3 � � I,/,e..7�r�J�r� �V� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />MaJ Adtlress <br />C1�Y <br />C�ty <br />StatelLp <br />Stalelbp <br />���aG-3 <br />c- � 3i/�i83 <br />Phonc <br />Phone <br />�� '5���-%'� ��� �� 5%-�/i.✓ 5��, wxo�(.�1� �f S 2y2- <br />EleclricalConiractor MallAtlaiess Gty Slale�Z�p C���6.0-Phone <br />7bgZ <br />�K L"�� 3y%f 9' <br />State License Number <br />Proposed Use ol E�uilding <br />Square Footage (If residenlial new conslruclion, remodel or adddion) <br />Number ol devices (II low vollage) <br />Description of Work to 13e Done� � C.f�vl �e <br />�e <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />� `�" G� — <br />Contracl Price ol Work <br />Contacl Person (Plan Review) <br />I hmeby ccrfdy lhaf 1 ha��c rcaJ and exarnined fhis apphcabon and Iviow thr, somc fo bc fn�c and <br />r.orrr.cl All provisions o/latvs and ordinances goveminy Ihis (yP� o! wod< <vdl he cnrnplr,led <br />whefhcr spcalfed hcrein or r,o� 1he gi�nfing o! n permd docs nof presume lo give aidbonty lo <br />VIOIdIL` OI CBRCCI U7C /)IOVISIUII: ol any ofl�cr sfalr, orlocal law rcgulaGn9 consfniction or fhc <br />perloim��nr.e o/ronslniclion Thaf I am a�dhonzed by Ihe owncrol Uus Praperiy fo pr.rlonn Ihc <br />�voik Ior which appGcalion is madc and I comply wdh Il�r. Sfafr. Gonfrac(o�s I.aw 18.27 RC W and <br />29G 2001h�FlC. <br />//-2�'-?�/� <br />/ ignalwc <br />ar w::i i� mao <br />�« - ---- <br />�5 0� <br />PI:RMTT1/ <br />E131(���3 <br />