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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org �"�`"�y <br /> � I k0�--�U/ <br /> S'�o t 23�� P��e � <br /> �Je�^r, �� 9�203 <br /> PROJECT ADDRESS <br /> �y po�y � r�� �..,� s,o� 23��.�. � �.re.�.,.� �a� ��3 <br /> �wne�' MailAddress City Slate/lip Phone <br /> �u2s) 3�8-�BoS <br /> S,RM� <br /> Tenant MailAddress City State/Zip Phone <br /> /� p v�s-�.� <br /> ��,.��1/P�' (��`r� l��e v`�i�'��c— G�,a,,�. e...o d�t" !.i�" �f 003;6 ai�� <br /> Electrical Contrador Mail Address Cily StalelZip Phone <br /> ��(� /�J �7 � ��f� D S— � �aoo <br /> +— � Coniract Price of Work <br /> Slale License Number <br /> �wt ��ev1 <br /> Pwposed Use of Duilding Contact Person (Plan RevievQ <br /> �,s <br /> Square Foolage Q(residenlial new consiruction, remodcl or addition) <br /> 2 <br /> Nurnber o'devices Qf low voltage) <br /> 6 !',.�w11 �n�.T� ��1 �a�.,rM e� <br /> Descr�tion ot Work to 6e Done: __ - -- <br /> 02 �w5cG.1� w�o�er-�ornr c:�e.cc'r,cA.� ��a.T:n __ I <br /> �3 1�10�.:�.� ex�s�:'ng �� :n� CPas:,-;av�i �+ -�'eTt'h:s) <br /> � �tk �--- fcpl�c� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX c:ODE IS �105 J^J)v� <br /> • /v <br /> I hereby ceAily Ihat I have read and examined fhis applicalion and know!he same fo Ge tiue and <br /> co�rect. 1111 provisions o/laws and ordinances goveming(his type ol work will be completr.d <br /> whclher speci�ed hercin orno(. ihe granung ol a permif does not presurne lo give aufhority fn PERMITB J �� � <br /> violafeorcancelfheprovisionsolanyofherslafeorlocallawregulalingconslruclionorfhe r I �O � <br /> performance ol r.onsiruc�ion. That I am aulhonzed 6y fhe owner o/fhis pwpeAy lo pedoim(he C <br /> work/or v�hich applicafion is madr, and I camply wilh Ihe Sfa(e Confracfors L�w 18.27 RCW and <br /> 296.200 WAC. <br /> �,.�,,. �.�Wew (n���9-------- <br /> Si9nalure Dale <br />