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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 `�� <br /> 425-257-8810 - �AX 425-257-8857 —www.everetlwa.org �J`��•� <br /> Civa3�1�3 <br /> 'b�o� 1��* h•� �� �•-� � <br /> PROJECT ADDRESS <br /> �bki�lSoN FAM��1��-� `��dS%�iRA,�Y �..v��'�wR�BZo 3 4Z5-�5 <br /> Owner Mail Atldr::ss City Slale/Lp Phone <br /> �"#,� ��R�nn �rvS�Q+�N� 4,�,S3i(o �6b <br /> Tenanl Mail Add�ess �:1ity StalelZip Phone <br /> � N �.E�'�Ghl,e-c� {� � � ��4T �dZC�b `F�-���/ <br /> ElectricalConiractor MailAddress Cily Stale2ip Phone <br /> ����c.�-lPcr — <br /> Sta�e License Number Contract Price uf Work <br /> OGA c,� [�J�C-s- <br /> Proposed Use ot Building Contacl Persnn (Plan Review) <br /> Square Footage Qf residential new conslruclion, remodel or addition) <br /> Number o(devices(II low vollage) <br /> Description of Work to Be Done: `^S ��N C-1�L�� '+ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �O� <br /> 1 hereby ceAily(haf 1 have read and examined this applicafion and know(he same fo be Irue and <br /> conecf. 1111 provisivns o/laws and ordinances,qoveming(his type o(work wi/l be completed <br /> whefher speci/ied herein ornoL The g�anfrng o/a permif does nof presume lo give auU�oiity fo PERMIT(1 <br /> viola(e orcanr.e!Ihe provisions o/any othersfale orlocallaw�egulafing consfniclion orfhe <br /> performance ol consln¢(ion. Tliaf 1 am aufhorized Gy fhe owner o/Ihis pmperty(o peAom�Ihe E � t-( p3 - � `3 <br /> work lor which applica(ron is made and 1 r.omply wi(h Oie Sfa(e Confiacto�s Law 18.27 RCW and <br /> 296.200 W�C. <br /> � �.� li� <br /> Signalure ale � <br />