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� <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wv�nv.everettwa.org <br />%� 0 � �n��, �-� 1�•ors e �. � \ <br />PROJECT ADDRESS <br />Ovmer <br />ienant <br />f n� 2�io`1 u <br />MaJ �tldress <br />tdal AtlCress <br />Ciiy <br />City <br />� <br />9 �-�� u �"� � <br />G1���-cz� <br />StatelLp <br />StatelZip <br />Phone <br />Phone <br />��in ��tc �r�'� 290 S/bf �`�C S� P���%/ �f� 99'U/� �ZS ZG� sS9 <br />Electricai Contractor ldaA Atltlress Cny StatelZip Phone <br />Qus� ��e .�' 8 8 3� C� <br />State License Number <br />�f s <br />Proposed Use ol Buildmg <br />Square Footage (II residential new construc�iun, iemodel or adduion) <br />� <br />Numher ol devlces ;II low voi�age) <br />p� �-o <br />��u <br />Contract Pnce ol Work <br />Conlact Person (Plan Reviev+) <br />Description of Work ta �e Done. O v a L' �2 S 5 `��-� ��i' l�t�r� 1� . �{ v(7 O Y�� � R l� 2�HMp <br />k—f <br />� PDl'C L'IV <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 bereby cerfity that 1 have read and exanrmed fhis applicafion and know Ihe same fo be frue and <br />conecf. All p�ovisions ollaws and ortiinances goveming this type ol work rall be complefed <br />whether speafied hciein arnot The granling o/ a pennif does nol pmsume fo give aulhonty to <br />wolafe or cancel the p�ovrsions ol any ofher state or loca/ la�v re9ulatrng constn�clion or fhe <br />peAonnance o/consfmchoa Thaf ( am aufhonzed Uy fhe o�vnero�fhis property to pedorm fhe <br />work /or �vhich applicahon �s n he and 1 comply wdh the Slafe Confracfors Law 18.27 RCW and <br />296 200 W� <br />�G' / � _ �✓ �� z6�� <br />r�e�ase� vza�i+ <br />FEE <br />�^ O� <br />J <br />P[RMIT# <br />E1311-OUg <br />