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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.everettwa.org 3 `��`�(� <br /> C.�l 4a3--��� <br /> � 921 �I TN- l�u � s� <br /> PROJECT ADDRESS <br /> C'��d/'cr► /�I2� ._J9 n� �ut s� frifzFrr a-4 _ 1'&4oF� yz7 3✓(o r5� <br /> Owner Mail Address City Slate2ip Phone <br /> C�IIVVt!/� S �w� c a S A-�4nvr <br /> Tenant Mail Address City Slate/Zip Phone <br /> l7 <br /> .� }'l� � Z�'iz /� � ��rc r�- ,��►� w,� 9 K`lGz z s3 �?z 3 Frz <br /> Eleclrical Conlraclor Mail Address Gily StaleiZip Phone <br /> /00�/ — <br /> Stale�icense Number Conlract Price o(Work <br /> \(C(S S"t�t �tC.r�1 <br /> Proposed Use of Building Oontacl Person (Plan Review) <br /> Square Foolage Qf residenlial new constrvclion,remodel or addition) <br /> � <br /> Number of devices Ql lov�voilage) <br /> Description o(�Nark to De Oone: �__rf_(/���"�' „• ��� <br /> FFF <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 ''l a .5 O <br /> I hereby certi(y(haf 1 have ieaJ and exarnined!his applicafion and know Ihe snme fo be In�e and <br /> correct. /111 provisions ollaws and ordinsnces�oveming lhis type ol woik will6e complefed <br /> whefhcr speci�ed hr.rein ornoL The gran(in�o/a permit does nol p�esume fo givc oulhonly(o PERMfTJJ <br /> violafeorcancel(heprovisionsolanyolhersfafeorlocallawregulahn�conslrucfionorfhe E � �D3 _� �� <br /> perloimance o(cons(nrction. That I am aulhonzed 6y fhe avner a/Ihis pwpe�fy fo peRorm fhe <br /> woik/or which applir.alion is madc and 1 compty wilh the Slale Con(�acfors Law 18.27 RCW and <br /> 2 6.200 WAC. <br /> �-� ��� <br /> ignalure� Dale <br />