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ELECTRICAL PERMIT APPLICATlON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREI'T, WA 98201 <br />425•257-8810 - FAX 425-257-8857 — wwvo.ever=ttwa.org <br />a�y �,d►-�, �►r,�. <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />� ��r- aa-� s... <br />Mail AAAre55 <br />Mail Atltl!e55 <br />1��� � L" <br />City <br />Cily <br />g��3��3 <br />[�-- i 3 o�—a'1S <br />' �, a <br />Slale2�p <br />Stale/7.ip <br />�.� <br />',f�S �-t� g <br />Phone <br />Phone <br />d <br />(}, � W��-, E�ecr��� � ss4c�a.�Sr �a�fi(.� �,,�q�r3`� ��3 �sas <br />Electrical CoNractor Med �ddress Ciry Slale/Zip Phonr. <br />�3S Yc��� ��J Q2S'�l h� <br />Stale License Number <br />�n � ��-r�.,-n•�`� <br />Proposed sc ol Bwldmg <br />54uare Footage Qf residenlial new construction, remodel or adddion) <br />Numbcr of devices (It low voltage) <br />C�J�� <br />Contract Pnce of Work <br />�. I P"10�C3'��" <br />Contact erson (Plan Review) <br />Descnptlon of Work to Be Done �-� 1��� S �� m� �� S�JLU ���l.lrn � <br />T <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />1 hr.reAy .m.�L/y Ihal I have iead and exarnined Ih�s applir.afio�, and kno�v Ihe s�mie fo be fine and <br />f.OIR.'f,I. AII nIpVI510f15 OI Id WS 11I1(J OIlI10,9fIf.CS IJOVClOIIIfJ UIIS ly(1@ OI WOA( W��I I1C f.0lDF>IC�C(I <br />whr.11�r.r spr.r,dir.d hcran or not. Tlu; grnnfrnq ol a pr,imrt dae:: nn� p�e;:ume fo grvc iu(hon'y fo <br />violale rn cancel lhe provisions o/ any ofher sfnle or Iecai la�v mgulafm9 cons7n�cGon or fhr. <br />pedormance o! consfmr,fion. Thaf 1 arn atdhorizeA by Cie ownn.r o! Ihis propr.rty lo perlonn Ihe <br />H�ork lor K-hich app6cahon �5 made and I comply wdh Ine Stafe Contracfors Law 7827 RGW and <br />296 200 WAC <br />R��,.�� v.,,,,, <br />FEE <br />��° ��-- <br />�F'ERM[Ttt <br />E I ��0`6 - vi b— <br />� <br />� <br />