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ELECTRICAL PERMiT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982G1 <br />425-257-8810 - FAX 425-�57-8857 - www everettwa.org <br />Zq�p -�e,r,,;,�� /��� (zqo5iaoo3oo300� <br />PROJECTADDRESS <br />s-o6-�y <br />C ,��os_��� <br />po�� o� ��vc}t Po Qdc S� Ev�e.h (,�4 5�Zo6 �-iZ�i 7L.78 <br />Owner tdad Aearess C�ty Siale2ip Pnone <br />j¢+�.2 4i C�ooJG <br />Tenant Naa naeres•, <br />ConlfaQOf M.ad Atltlrc55 <br />\/Au-F�GI�I i N A <br />Slate License Number <br />�r�Mr•trci a� _ <br />Proposed Use ol Build�ng <br />Square footage (II resitlenlial new consWctioq remodel or adddion) <br />Number ol devices 01 low voltage) <br />Cily <br />City <br />Statc2�p <br />w+°a �FbZo3 425-Yb� <br />Slale2ip <br />a S�s, o�o. �- <br />Contrad Pricc of Work <br />Contact Person (Plan Review) <br />P�one <br />P�one <br />Destnplron ol Work �o Be Done Sr�<ro�l�i'�O� O� ��T� �'c�c'-i ,, n� dGcs+� ypr nn?�t � i ��bA •��f <br />i <br />i <br />PK�fh.__nt c�, rct.�, o� C_aK�bllenJ�_C?cc'a��t1J/`��,-�cc�Lo�t�= 5c v>.o <br />V <br />CITY OF EVERETT IOCAL SALES TA% CODE IS 3105 <br />I bereby ce�6ty !ha( I have read mid exammetl Ihis apphcehon and know (he same lo Ge Irue and <br />colrect All provisions o! laws and ordmances govemmg fhis type ol wo�k wdf be compleled <br />whether sPecdieA hemm or nof. 1 he granfing ol a perrnif does nof pmsurne fo qrve aufhonfy lo <br />viofafe or cancel fhe provisions ol any ofher s(a!e oNocal la�v mgulaling consfn¢fion orlhr <br />perlomiance o( cansWchon. Thal l arn aulhonzed by fhe owner olthis properiy lo perfo;m tlre <br />work lor which app6caGan �s madc antl 1 compty wdh fhc State Conlraclors Law 1 B.27 RCW and <br />296.200 WAC � <br />S <br />F[V�SCOL.'Da) <br />FEE <br />IZ�O°% <br />PERMIT# <br />E1405- U37 <br />