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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetN.,a.org <br />PROJECT ADDRESS <br />tJ 1�2. <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City Siale/Zlp Phone <br />//ll y� )37�-/S/�/ <br />�Uc rIUjII k�,-cTr,� r� t�rX .2v�L' S1\)()Nc1j11S11 W4 ?YY w <br />Electrical Contractor Mail Address City S!atelZip Phone <br />. ri <br />State License Number Contract Price of Work <br />pp I n <br />Proposed Use of Building Contact Person (Plan Review) <br />855 <br />Square Footage (11 residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: �I r �n a I 1 7r r' /N re it za'' a rPG S • l d 4 : <br />r;�'•.' . o r7(•(!'Ir%/on. / �,ror.,fo.: /yN .�k,s7 N,.- 1�r�/ i fP JC'r rl'�,.7r•l Srlmc%'� � (tU �? l Y.?ter <br />IAS J3r"�' N?r,J C C `r �K S N /n116r\P <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 -75 OP <br />1 hereby cattily that I nave read and examined this application and know the same to be fate and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified heroin ornot. The granting of a permit does not presume to give authority to PERMTT>9 <br />violate or cancel the provisions of any other state or local law regulating conshuction or the r <br />performance of constmction. That lam aulhonzed by the owner of this property to perform the L 1 j } I — 00-T <br />work for which application is made and I comply with the State Contractors Law 18,27 RCW and <br />296,200 WAC. <br />v Signature Dale <br />REVISE) 12WJ --� <br />i5 <br />