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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />6�-tv/307-007- <br />IC.ISi PL SC U1JlT k <br />PROJECT ADDRESS <br />tot Z lot SE <br />�1A t1l�Uta Ar4•000 f�v�. rt ruff 1982c2 Z 9<� <br />Owner Mad Address City State/Zip Phone <br />lit- IUISi F1^ S:R (/ <br />nnw, WAi_�() tZd(�/t t3a-'r % f��C 2lGYf W� I9St[ i <br />Tenant Mail Address City Stele/Lp Phone <br />Z40�. <br />= L4j tf[�s Volk— -7Z� rk1all <br />Electrical Contraclor Mell Address City State/Zip Phone <br />State License Number Contract Price of Work <br />Proposed <br />Use l Rding ff t Contact Person (Plan Review) <br />Proposed Use o 9uilding Lfz% <br />, (J SQ. F'� 3tr4j 8b I b <br />Sq a Foolage (It residential new construction, remodel or addition) <br />Number of devices (If low voltage) /�,,� <br />Description of Work to Be Done: ^101 � TwiiA)_3L (G d ���� PrC!& C3.-D <br />I x SL ter �za= _MU�� � SMre� fl t��ca1L -� �, rr�ceofn c re <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE 1S 3106 <br />I hereby certify Ihal I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to PERMrr# <br />violate or cancel the provisions of any other state or local law regulating construction or the I >� 7 <br />performance of c nsttiction. That I am authorized by the owner of this property to perform the _ oo L, <br />work for whlc t rpke Short is me and I co ply t the State Contractors Law 18.2; RCW end <br />296 200 WA ' _ <br />-7j <br />igna ure ale <br />REVISEO NW13 <br />