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I - — -- -- --- – ------- <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE[T, EVERETT, 1,'VA 98201 <br /> 425-257-8310 - FAX 425-257-8857 —w��nv.evereftwa.org <br /> 271� 5j� 57" <br /> PROJECTADDRESS <br /> Ownef 69ailAddress Cily StatelZip Phone <br /> Tenant h7ailAddress City SWte/Zip Phone <br /> (Uz�D� S�k. G����r�lcc . �Zs2.y�',�,� NEs�rkL-3�3 ��.�S�;NLw�"�6��� �6-�3—rS <br /> EledriCal Contfactof Mail,4ddress City £tale/Zip Phone <br /> C�II kCS �= £SS1 �1� bSLZ � <br /> � State License Number(required) Cily of Everelt �usiness License Number(required) <br /> I <br /> -- ----- ' <br /> Proposed Use o(Building Contract Price o('Plork � <br /> �WI� <br /> �_�yz�- 367- 755 ) <br /> Square Footaye (I!residential ne�,v construction, mmodel or addilior.) Conlac rson/Contact NumbedEmail <br /> Number of devices(If tow voltage) <br /> Description of Wark �o Be Done: � ��_J — I z0°°�T 15�n� U���'l -ip� /!p I't�+�{ OJ�IC T <br /> c.�J �-�I�� �l�-�5 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 'li /—' Ob <br /> ��1� / <br /> 1 heieby certi/y that I have mad and examined(/tis�pplicafion and kno�v the same lo be(n�e and � <br /> conect. All provisions o/la�vs and ordinances goveming this(ype o/�ti od<<:rll be comple(ed <br /> �vhefherspecifred he�ein ornot. The granfing o(a pennif docs not presume(o give authonty to PERMIT# <br /> vrolafeorcancel7heprovisionso/anyotherstateor/ocalla�v�egu/atingconsiructionorlhe � r <br /> pedormence ol cons(ruction. That I am au(horized by fhe o�:nerol this p�operfy lo pedonn Iho I/�h�� ( �5 <br /> work for which application is made and I cornpty with fhe Slate Con(racfors La�v 18.27 RCW and � � v � <br /> 296.200 WAC. / <br /> ✓ ��/� <br /> Signature Date <br />