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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES a_�o-I y <br />3200 CEDAR STREET, EVERETT, WA 98201 �,,� ba..�23 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />2� a 2 � <br />PROJECT ADORESS <br />�, � � v P-�-✓ <br />Owner <br />V��-a-�'f' <br />Tenan� <br />(7 W �s-✓ <br />Eleclrical CoNractor <br />,,� �: + �-� <br />�0�o�13i��� <br />Mad Address <br />Mad Addicss <br />MaA Address <br />Slale License Number <br />�, �,�Ny <br />P►� <br />Proposed U�e of (3uilding <br />ly ov�' <br />Square Footage Qf residential new conslructian, remodd or addition) <br />Number of deviees QI iow vollaye) <br />, <br />Desuiplion af Wark lo He Done: �'`� � <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />� v�✓ e�, w� �� Z� I <br />� fl �z�) <br />w A`t�c� z z3s z3z� <br />Gty <br />Cily <br />Ciiy <br />State2ip <br />SlatelZip <br />Slatc/Zip <br />�� SD c7° � <br />Conir2d Pricc of Woik <br />Contact Person (Plan Reviev�) <br />rnone <br />Phone <br />Phone <br />v�� I,��P�P w;�es ��°�- �°� �1�Jl�s <br />/ <br />1 hcreby ccrtily fhaf 1 h. ve rcad:�nd examined Ihis applica(ion and knmv fhe same lo br, tn�e and <br />r.nncr.L /111 prnvisions o/laws and ortlinanr.es 9oveming Ihis lypc ol �vadc ttiill bc camplefcd <br />whc(hcr'specilicd hercin ornoL The granfiny ol a pennif docs nof proswne lo givc aufhonty fo <br />violate or cancel thr, piovisions o/ any olher sl��(r. or lor.al la�•� regidaliny consfruclion or lhe <br />perioimance o/consfn�ction. Thaf I am aulhorirr.d Uy fhe owner o/lhis prope�ty fo perlorm Ihe <br />work fo� wl!ir.h opplrcalion is rnadc and I comply tvilh Ihc Stalc Conl�ar,lors La�v 18.27 RCW and <br />29G.200 WAC / <br />��'�,�" " � z �� / ( � � <br />----- ----- � -- <br />Siqnalure Date � - <br />r•cv�scn v�mn <br />r-ee <br />��� <br />P[RMITY <br />E��b2-123 <br />