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�� I Z 1 C' _ l i -; <br /> ELEC:TRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE77, WA 982�1 <br /> 425-257-8810 - FAX425-257-8857—www.everetiwa.org <br /> 1002� 12� ��Pi� �/���� ������ <br /> PROJECT ADDRBSS <br /> ���/ 28/S . /� SU/ � '� <br /> (hvnef Mail AcYd <br /> City StatefLip Pho�x: <br /> ' " /� C� SlaldZ�p Phone <br /> Tenant Mail Add�ess <br /> ' d d ��/�����li' �lG� �� ��U�it, ��Y l�/�l �1 f�D27, <br /> -� c�ry smiemv w � <br /> Electncal ConUaccor Moil Address <br /> r /I �p. D l/ <br /> pr�Gi� ��y� � ' <br /> t�License Nurt�ber ConVad Price ot Work <br /> , , lliL/ / <br /> Contacl Person (P�an Rc � W) <br /> Pro d Usa of Building � <br /> Square Fool2ge(IF residenliel new consWction, remotlel or eaainon) <br /> Number of devices(It low voilaga) <br /> Oesc�ipbon o(Work to Be Dona: �� U `� <br />� <br /> i <br /> FEE <br /> � CI'iY OF EVERETT LOCAL SALES TAX GOD6�8 3105 ����� (�.�i <br /> � 1 hore6y cerh7y thnt i have road and oxamined this npplicadon and know Bie same to bo frua and <br /> co�roct. All prvvisions nf laws and o�dinoncos poveminfl thls typo ol work��ll Ae completad <br /> i whalher spoclFod heroin arnoL The grsnh'ng of y permit does nof prosumo to y'rvo autlro�y to PERMC�# <br /> violofa or Cdncol t0o prOvisims of any ofhvr stnfo orlocal law rogulah'ng con5troction ortho ?,.;; .I -_ l L.�, !__S <br /> pNrlonnance ot consW�on. That I am authonzad by fhc ownorof this properrylo pedorm!he E ( " � 1 <br /> work lor whlch applicafion!s made and 1 canpiy wrfh fhe Stofe Contmcfors Law 18.27 RGW'and _ <br /> 296.200 WAC. �� <br /> � /l( 1� <br /> - ature A�` . <br /> REVISEO YM'13 <br />