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t <br />ELfECTRICAL PERMIT A�'PL�CATION <br />CITY OF EVERE�"T PERMIT SERVICES <br />3200 CEDAR STREET, EVEP.ETI', WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�� 0.5� �� �l� �it�c� S�- ci a'�, 5' <br />PROJECT ADDRESS <br />C�wner <br />Maii Adtlress <br />City <br />StalelZip <br />� --/ D -- / Z <br />c- �zo7�3 b <br />Pnone <br />Tenanl � MailAddress Ci�y SlalelT_ip Phonc <br />�fZS�-��306�� <br />��C C.=?��_ � s Z2 r2cuc r�l�wr� �� �� S� �rl/ <br />[IectricalCoMractor MailAddress C�ty Siatc2ip Phonc <br />L��d'� �!-l�.l Ci'! � �J' c[/ <br />Slate License Number <br />!/�'1L�� r`.� ��r•,.� t� � 4 - �� e ?c�- <br />Proposed Use of Building <br />�ODD C7 � <br />Syuare Foolage (U residential new construclion, remodel or addition) <br />ConUact Price o( Work <br />fJ� � �— <br />Contact Person (Plan Review) <br />Description of Work Io [3e Done: ��3 c—ii\7 -Ft�''– ?—�3 �i� ���(ZC ��'E7t,�G <br />�'�y�-�R �xz � 52f�/I C e <br />NOTE: WIRING IN NON-UWF_LLINGS IS REQUIIZFD TO <br />�E IN RPCEVVAYS, MC OR AC CAE3LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />���� <br />I hereby certily fha� I Irave read and examined fhis applicalion and know flre sarne (o be liue and <br />conect. All provisions o)la�vs and ortim�nr.es yovemmg lhis (ype o/ work will bc complefeJ <br />vdhe(hersper,�(cAhcrcin oi nof. The yianling o/ a peimd dacs not p�esurnr, fo ,roe aulhority (o <br />viola(e or cancel fhe provisions o/ any ofher sfatr, o� lor.�l la�v myulalin� cons(nicfion or the <br />peAomiance ol conslructien. !"haf I �m �ulho�ized by the owner ollhisp roperly (o pe�lorm Ihe <br />work lo� which &pplica(ion is niade and I cnmply �wth Ihc S(a(e Confraclors f aw 78.27 RCW and <br />296.200 WAC. <br />- _ _-- ---- O � cv ?-�J l Z_ <br />Sig alure Dale <br />FEE <br />75 � <br />��ZO� - 03�0 <br />