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� <br />r� <br />U <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — w�.wa•everettwa.org <br />I o�e �q.�� � sE <br />PROJECT ADDRESS <br />6_�--/ S' <br />C-, S�h-��1�/ <br />� <br />I na�� d i�� � or S�— �a �� 33 a• 3a �� <br />Ownef ���a�� Atldress C�ly 5t5ta�Zip Dhone <br />Tenanl <br />1.1ai1 Addross <br />ary <br />State2ip <br />Pl-onc <br />Qr �.�.h.a-�, U�a-� r�y � o � s � 3� t�� SvA�-11-� , wo_ G�p� t�e ,� o� a y 6� o <br />Electncal Contf2Ctor Mad Atltlrcs; Gry S;alcll�0 Phono <br />� W.,r�.q �a � <br />Statc liccnse Number (reqUired) <br />�� <br />Propo,ed Use of BWiaing <br />Square Footage (If residential new consWction, femodel or �ddilion) <br />Numbcr of Oevices (If low voltage) <br />Descnphon of 4Vork to Be �anc <br />l� C.�rc�i� <br />CITY OF EVERETT LOGAL SALES TAX CODE IS 3105 <br />oa8 30 <br />Gty 0� Evereri 8usine55 l!�:ense Number (rE^•uiretl) <br />�'3� <br />Contr�ct Pnce of WOrk <br />_�Qam�-�-I�Db•�`I6- `�i Ob <br />Gontact Pers n/Contact Number/Ema�� <br />�Y <br />I hereby cerii(y fho( f h9ve /Eed d�d ezamined f�ls appGcafion and know fhe same fo be frve and <br />conect. a!I provisions ollaws end o�dinances govemmg lnls typo ol work wi7 be compleleA <br />whefher specdied herem ornoL The grenting ol e pPrmll does not presume to give outhodty to <br />wolafe or cancel Ihs prov�sions of any otne� stafe or locef low regWafing construchon orlhe <br />performence 0l consfroclion. Thdf 1 am aufhorized by the owner o!lhis propeAy to perlorrn fhe <br />work /or whicb opplication is mpdf ond !�omply with the Sfale CoMiacfors Low 18.27 RCW and <br />'�41i100 WAC. <br />nFmSc,�iunsooia <br />� <br />FEE <br />L'� �� <br />J U <br />PERM1Til <br />E�5 �C� -D�fO <br />