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! ELECTRICAL PERMIT APPLICATION <br />� CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />i 425-257-8810 - FAX 425-257-8857 - www everettwa org <br />1 � /�� �'�� l°� S `-.�.' l�� <br />PROJECT ADDRESS <br />_ _/"�I�,�Y � <br />Owner <br />lenanl <br />Ma�l Addre55 <br />-�'� - ---'Mail/lddress —. .. _ <br />Gry <br />Cny <br />State/Zip <br />Stete/Lp <br />/Z�d +'7'�r�^ h . _ . �5.� ��� � Zr/`. �_ _�� �., <br />Eledrical Conlractor ManXddrrss Cny Slalel7ip <br />•+-� �r I, <br />State Licensr. Numbcr <br />Proposcd Use of Bwlding <br />Square Footage QI resiAenhal new conslruct�on, remodel or addilwn) <br />Number of devices Ql low vollage) <br />Descrlption ol Woik lo Be Done. ��_ _� �` O� <br />Conlracl Price of Work <br />Conlacl Peison (Plan Reviewl <br />PAone <br />Phone <br />Phone <br />.1/.. .•`�-�' -I't/6 I..� ��%D h? � <br />Z� <br />FFF <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 �} ,� <br />W <br />I hemby certity th�t 1 have mad and eram�ned Ih�s appDcalron nnd know fhe srunc fn be Gue and <br />r.ormcl All pmv�snns o/ l�ws end orzlinances gavrnring fhis type o! work wi0 be cornplefr.A <br />whelhcr specrGed hemin or no( !he granhng ol a pemuf does nof prnsmne lo groe eulhonty fo PERMiTk <br />wolafr or cancel fhe provrsions ol nny ofher sfale o� lucal law regulehng consbuchon or Ihe ^�`O r� O� <br />pedonnnnce ol consfrucGon Thaf I am eulhonzed by Ihe owner nl fhis prn �erty In peAom� Ihe t � U � <br />wnA� lor wluch apphcelion is rnade and 1 comply wdb fhe 51afe Conliacfors Law iB 27 RCW.ind <br />: 96 <^00 WAC <br />--- --- nalur�L?C//=`�� ---�— --- �e--/�lL� <br />Hr � �•� r 1 �;: � � <br />