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� � I <br /> ELECTRICAL PERMIT �►PPLBCAT'VON <br /> CITY OF EVERETT PERMIT SERVICE� , <br /> 3200 CEDAR STREET, EVERETT, b'VA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org ' <br /> �j a0� 5-�� ��, s�.. �� �� <br /> PROJECTADDRESS <br /> �t.r�� 1�����,<< 1ao sw C�„-� t����wa.� Ev.w.� �J/n �l�U�} �5�3 gUU <br /> Ownef MailAddress Cily Stale/Zip Phone <br /> Tenanl MailAddress City Slatel2ip Phone <br /> l. o`�l 1 b6� 1��1 UJ v� ��0`61� �a,533�5 �S <br /> �e��,�n �.le��i, �,(� ,� a �c1� <br /> Electrical CoNrador MailAddress City Stale2ip Phone <br /> Stale License Number Conlract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Foo�age(It residential new conslruction,remodel or addition) <br /> Number of devices(I�low vollage) <br /> Description of Work to Be Done: ����) 1^ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 �/1 6� <br /> l/ <br /> 1 hereby certify fhat(have read and examined Ihis application and knov�Ihe same(o be true and <br /> correct. All provisions o/laws and ordinances goveming this type olwork will6e completed <br /> whether specified herein.ornot. The granting ol a per.mi!does not presume(o give a�thority to pERMIT# <br /> violate orcancel fhe provisions olany otherstafe or loc�l law regulating construcfion orlhe � <br /> performance ol constmclion. That I am authonzed by fhe owner o/Ihis propeAy fo pedorm fhe I � �� -o� ( <br /> work Por w ' h application is made and 1 comply wifh the Sfafe Conlracfors Law 1B.27 RCW and <br /> �6. <br /> , S � s � ►� <br /> Sig ture Oat <br />