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, ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-6810 - FAX 425-257-8857 —wwv+.everethva.org <br /> �3�� 5���1 J� �t/[1�� � 1 � � � —� �� <br /> PROJECT ADDRESS � a - 5 `�Y <br /> Owner Mal AtlCress Giy Stale/Z�p Phone <br /> Tenanl htail Address C�ty Slate2ip �Phone <br /> 1�., � �I� l=�« -,�. GC� �Yu 3tif' l'�� � � <br /> � u� ..��I� �,3`63 !'1�����//a t�ll ��27� �Ks-7375 <br /> � <br /> Electrical Contraclor 61ad ACeress City SIa;MLp Phone <br /> ,5 �T �= rS� �s��4� o�,3Z� <br /> State License Number(required) City ol Everett �usiness License Number(required) <br /> L�� — <br /> Propos�se. .� 13uilding Con�racl Price of�Vork <br /> �oo yzs - s�� -�375 <br /> Squ�ie Footage(II residenlial new construction, remodel or addrtion) Contact PersoNContatt NumbeNEmaJ <br /> 3 <br /> Number ol devices pf low voltage) <br /> [ 1 c <br /> Description ol Work to Oe Done: r���' VG^'luqe ll°''�'�- Wa�� A'� OY� '� _ <br /> 1 <br /> W;� :,1 I�.ne ��c' Cot�e__ �I:��cE.,��, � seiv�'c �� ,-�5�c,1��� �v a�ofh�� — <br /> [0'1�'�c.�fo� 1 ——` -- ---- <br /> / <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �%1� <br /> V � <br /> 1 herehy certily lhat 1 have reaU and examined fhis apP�ica(ion and know fhe same l0 6c fnie and <br /> cormc�. AIf prowsions o/la�vs and anlinances gove�ning lhis type ol�vo�k will be conrplcled <br /> ��rhelher speci(ed hercin or noL 1 he granting ol a pennit Aoes not pmsume to givc oulhonty lo PERMIT� <br /> vrola(e orcancel the pivv�sions o!�n}�others(afe or local larv mgula(ing cens(ruc(ion or(he � I � � � ! n 2 <br /> perfomiance olconslruction. That 1 anr avfhorized by fhe o�vnerol this property to peAami fhe (� �� <br /> w.ork lor u-hich applicafion is made and I r,omply�vi(h the Slafe Confracfors Law 78 27 RCW anJ <br /> 296.200 WAC. - <br /> i <br /> i �a -5- ,� <br /> �Signalure Date <br /> i�E1'i5(D P,NP'.:Ov <br /> L- — --___ '_— <br />