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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT WA 98201 <br />475•257-8810 - FAX 425-257-8857 - www everettwa org <br />I <br />i � 9 �.� � � � �1 S �..� �� � <br />PROJECT ADDRESS <br />� �,�r /l <br />�I __L//�-+� f.� s?7 <br />. Owner ��s � Giy <br />Tenanl v Mad Aaaress <br />�l � <br />—�ii01'T�r�rr7 �+ �%. �` r f_ Z�7 G <br />Flerlr�cal Contractur � Ma��� Admess <br />, Sia�e Ucense Number <br />Proposed Use of Fl�Ndmg <br />Squaie Foolage p( residential new conslrucimn, remodel or addition) <br />Number o( devices (Il low vollage) <br />Cdy <br />Gry <br />--�--� SlOte/Lp — <br />Slale/Z�p <br />State2p <br />Coniract Price of Work <br />Contacl Person (Plan Revicw) <br />Descriplion ol Work to De Done _C�1 / ti �� Q O_ S/ /P7 /`� �C.(� �o •� �'' <br />r� <br />Vhone <br />Phone <br />PhonC <br />� <br />� <br />---- � <br />I <br />-- - _ --- - <br />I <br />ErF I <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 x D, iTT <br />V '� l.J I <br />I hereby ceAdy fhaf I have rr,ad �nd examrned fh�s epp6cefron nntl know fhr sarne fo Ae fnre onA ______ ._ _____ _ , . <br />correcf An provisions o� �aws anA ortlmances govrming fh�s type ol wnrk wdl be complefed --- --- I <br />whefher spealied herem or nof The granfing ol o permd does nol presume fo y�ve nufhonty In PERMI I# <br />vrolafe or esncel fhe pmvisions ol ar.y othei sfafe or local law regulehng consfruchnn n� Ihe — Q � <br />performance ol conslnichcn Th<�f I am eufhonzed by fhe owner u/ fhis pmp�Ry lo peilomr fhe E I�D� — O(� <br />wor6 /a which ePpGcahnrr rs maAe and / corrrply wrBr fhe Slafe Cun6ri[(ors Lnw 18 77 /7CW .vnd <br />796 ?GO WAC <br />— /��� <br />S gnature <br />K�. �......�� <br />��F��S.� <br />�aie <br />