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ELF.CTRICAL 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 � _��_�S� <br /> L�S'D l —L'� <br /> � <br /> jIU � `1 �°l `" qvE_ Sr STc ly � <br /> PROJECT ADDRESS <br /> n, �/y <br /> /�2� E�� '�c P� �n i nr's I101`I ��i ����c �L` r�l'r�2L7T l�/1 �'Ir%O`/ ���5-3�� ��uU <br /> Owner � Ma�l Address City Slate/Z�p Phone <br /> Tenant MailAddress Ciry StalelZip Phone <br /> i / ^ /' �,/ �t <br /> �� //✓/J�t/�i'1 � �.L�,T� —�/i//���' ��1�'�� 5 �i' 7iY�� � �+'�hv-+tti� �/�`1Q�1 Z �(f� � J%� 2 Z / C� <br /> Elec�rical Contraclor J J Mail Adc'ress City State2lp f�ione <br /> ��'•/il/�lSiJ� i �. ' (e � jZ �S <br /> Stale License Number(required)� City of verelt �usiness Li nse umber(required) <br /> ����lU �U --- <br /> Proposed Use of Building Contract Price of Work <br /> �u2i(oRN�i.f �U/� �`��-2Z/CJ <br /> Square Footage (If residential new construction, remodel or a�dition) Contact Person/Contact NumbedEmail <br /> Number of devices(If low voltage) <br /> Descriplion of Work to Eie Dune: ✓�-E' � ' L �-C ,'.�� '�'� �'t I„��a-I 1 ` r Ctl��v <br /> �i�N�n ., ' ��t,V-� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 G{/'� .J O <br /> I hereby ceAity(ha(I have read and r,xamined this applicafion and know fhe same(o be true anJ f `J ' <br /> comecf. All provisions o/laws and ordinances goveming fhis type ol work will be completed <br /> whefherspeci�ed herein or noL The granting ol a pemrit does not presume fo give authonty to PERMIT# <br /> violafe or cancel the provisions o/any other sfate or local law regulafing consfrucfion or the E �S D I -0 5( <br /> peAomtance ol consWc(ion. Tha(1 am authorized by fh�owner ol lhis properfy lo pedorm fhe <br /> work for which applicafion is made and J comply wilh the State Conf�acfors Law 18.27 RCW and <br /> 296.200 WAC. � <br /> �. / <br /> ,r,�7/ <�l'�.,,��i-�_ �' �7 ' /S� <br /> Signalure Dale <br /> aevrsEn oav�oi� <br />