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----------� __ <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-257-BS10 - FAX 425-257-8857 — www evereitwa org <br />� 3v w oo� /a w.� /�„ � <br />PROJECT ADDRESS <br />fi�o 6 i3 <br />C-�.3/i�Ja�6 <br />Geoqa�� �✓�/�(i <br />OWOBf i�AailAdAress Cdy Slate2ip Pnone <br />Tenan� <br />Idad qAdiess <br />GIy <br />StaleR�p <br />P�one <br />i°o,���. c�«. �3�ys Re�fe,� �� .��w wQ. y��3L <br />Idail AdCress Gty StalelZip Phone <br />EleclncalConiraclor 3�d 7S7 / <br />` o.'nf e�� �Y b' o/e <br />Slale License Number <br />/�GS/ r'/e� l�� �e <br />Proposed Use of f3uilding <br />Square Footac7e Qf residential new conshuction, remodel or addilion) <br />Number of devir,es (II low wltage) <br />Descriplion of Work �o Be Done: �'� e ✓� t�✓ <br />_{-ii'e ��e� �n Ce'i � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />s� o o, <br />Contrad Price o( Work <br />Contacl Pmson (Plan Review) <br />ci�cu f Tu/ <br />� /cc <br />1 hereby cerL(y fhaf I have road and ex,�mined fl�is applicahon and kno�•,� the same fo he l�ue and <br />r.orrer,l. �II prowsions o/la�vs anJo�dinances goveming Ihis typc ol wo�h wdl br, r.ornplcted <br />�i•licthcr sl�eaGcd hcrcm or noL Thc r�ronlinr� ol a pr.mut docs no( presurnc fo grvc aidhonty lo <br />violute or canr.el lhc provisions ol ��ny other slate ar lor,al law �egul�fmy conSUuc(ion or fl�e <br />per/onn;incr. nf consfn�clion. 7ha1 I am aufhon�ed hy (he owner nl (his property lo Per/onn the <br />work !or v��h�r.h applic.dion is nmde ond 1 compty �vifh fhe 5(afe Con(racfors Law 18.27 RCW and <br />79G.200 W/iC <br />_ ..—��i�� -- —��/�/� 3 ---- — <br />Signature � f)ate <br />(±E1 �Sf O �rOn t <br />FE[ <br />`��j0.�0 <br />PER��11 I !! <br />E� 3 I I-o z�--- <br />m <br />