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ELECTRICAL PERMIT APP�IGATION <br /> CITY OF EVERETT PERMI�' SERVICES � �a9-�3 <br /> 3200 CEDAR STREET, EVERCTT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org � 1307—13� <br /> 5�/��7 23��C AU'� <br /> FROJECT ADDRESS �U�Z��/ Q��O � <br /> �� ��—�� 5�07 23�d �� C� % � � <br /> Cit StatelZip /� � ?h/�1e �- <br /> Ownef Mail Address Y y L '� �� <br /> �r <br /> i1c't.ti-�.. <br /> �i� Stale/Zip Phone <br /> Tenanl Mail AAdress Y <br /> ���-fz%N 2��2 ��4��z�c �z rvy rs�� �� �� ���z��� c:��- F�Zo,� <br /> City Slate/Zip Phone 2 <br /> Elecirical Contractor Mail Address ���'L7—�2 <br /> �82iGf��'��9�,��� �vo• .�,� <br /> Contract Price of Work <br /> Slale License Number <br /> Contact Person (Plan Review) <br /> Pruposed Use of Building <br /> Square Foolage(if residenlial new construction, remodel or addition) <br /> Number of devices Qf low vollage) � L� �,(' <br /> � � ( ���� �/:,._�l i—` a-Vcc� <br /> Description af Work to Be Done: �F`-^� �' '�` `�i� � L �"' <br /> I FEF <br /> CITY OF EVERET"f LOCAL SALES TAX CODE IS 3105 L�Gi ��� <br /> I hereby certi/y fliaf I have read and examined this application and know the same lo be frue and <br /> correcf. All provisions o(laws and orclinances goveming fhis type of wo�ic will be cornpleted <br /> wbether speci(ed herein or not The granfing o/a permil does not presume to give authonty lo PERMIT# <br /> violate or cancel the provisions o/any other stafe orlocal law regulating construction or the r I �� � _ ` 3�, <br /> peifom�ance o(constnicfion. That I mn aulhonzed by the owner of this prope�ty to peifonn the [ � <br /> work fvr which application is mado and 1 r.omply wifh the Stafe Contracfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ��= �/�� '7-2`i�� <br /> c� �� , Dale <br /> — Signature <br /> pELISEO:i/20H3 <br />