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ELECTRICAL P�RIl��T APPLICATIC�f� <br />CITY OF EVERE7T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />'� 92 3 2�t`� �-�/� Vl� <br />PROJECTADDRESS <br />Ovmer <br />Tenant <br />� f=le.c�r�c <br />Eleclrical Contractor <br />M1iail AOdress <br />�dail Adtliess <br />0 �oX 2+oR <br />Irtad Adtlress <br />'��fi-� ►= �EZ �S 71 b� <br />State License Number <br />2�5� O��a� <br />Proposed Use of Building <br />2�58 �' <br />Square Footage Q( residenl al new construction, remodel or atldition) <br />Number of devices Q( low voltage) <br />� i 30 �-063 <br />6 .- �� �� 3 <br />C:ty StatelZip <br />City Slale2ip <br />�q 5�°V Ul/f� 983y6 � <br />���Y V Slate/Zip <br />3,�00 — <br />Contract Pnce of Work <br />Contact Person (Plan Revievi) <br />Descnplion of Work to 6e Done _�Z� 1Q �Q. v�XQ j � �/ 1 iL I NCr- Q� � -� <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />C <br />! he�eGy ceriily thaf I have read and exanrined (his npplicafion and kno�v the same fo 6e (nie and <br />conecf. All provisions o/ laws and ordinances �oveming this (ype �l work will be cornple(ed <br />whelher specifred hr.rein or nof. The gran(ing ol a pemrif does nol presume lo yive aulhonty fo <br />violate o� cancel !he provisions ol any other s(ate o� local !aw regulating construction or fhe <br />peAonnance o/consfruction. Tha( i am autlronzed by lhe owi.er o/ (his pmpe�ty (o pe�fom� (he <br />tvork /or which �ppOcalion is made and I contply tv�d� the Stafe ConVac(ors Lu��� 18, 27 RCW and <br />296 200 WAC. /, <br />—� � — � <br />aev�s[-a iz¢-r3 <br />Phone <br />Phone <br />36✓ <br />�s= <br />Phon= <br />FEE <br />�O � <br />PERMIT# <br />E 13��-�c�� <br />