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� <br />� <br />�LECiRICAL F'ERMIT APPLICATIQN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98?01 <br />425-257-8810 - FAX 425-257-8857 — www.everettvra.org <br />. <br />�� 1\\, . , , _ � ..� <br />i�i•aix • � � :��� <br />�f �aa-iy <br />C I�dy`��3 <br />�� . <br />Owner �daJ Address City StatelZip Phone <br />hlad Address <br />Mail Address <br />�`^�,��� v \ � �-/�1 <br />Slate License Numbcr <br />Proposed Use of �uilding <br />(If residential new conslruction, remodel or addi�ion) <br />—. � <br />Number ot devices (If low voltagc) <br />Descnntion of Work lo Be Done: <br />Cily <br />State/Zip Phone <br />a-t�-1r�3-- � <br />State2�p <br />Phnne <br />o�, C7\G . <br />Coniracl Price of Work <br />( Cl-�_-'>�.—\—� ��t'� <br />Contact Pcrson (Plan Rewew) <br />L J�71-t�[ \ GL C���t" a.s C' �� �.-c��v Ci��' .�1 t� . <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />! hert�by certily thaf I have read and exarnined fhrs applicaLon anU know fhr, same to Ge fnie and <br />co�ecf. All provisions o/laws anrl ordinanr,es yovernin�� fhis ty�:e ol work �wll Ge cornple(ed <br />whelher specified herein or nof. Thc g�anling ol a pennit does nnf pm ;ume to give aulhonty to <br />vie��lr, qr c��ncel the provisions ol any o(her state o� local law regula(inry r.onsfniction or Ihe <br />manc � o/constrt�r.lion. That 1 am aulhonzed by Ihe mvnerolfhis pioperty lo perlorrn fhe <br />woik �h ch applica � n is madr, and 1 coniply wiN� Ihe Sfa1r, Confiacfor; Law ±8 27 RCW ��nd <br />29G 200 C <br />_ -- � � � a a� � -- <br />.1F�.=Fn�,,.� <br />FEE <br />,�� vo <br />PERMITM <br />E i�o�- 1�3 <br />