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dpfl <br /> 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 /> /1?,; () /00Y/1 37—_SE Eveek_e --troisp— <br /> PROJECT ADDRESS . <br /> yy� eorivituivq, 144 # <br /> `/ I °y°5 ; eo scYI Si""A MA -A- S e.v-T WA- p8l° <br /> Owner Mail Address City State/Zip Phone <br /> 5eA-fii A /lou. / 7%' 192o/007A- Sir, et -7 C4PcPeiYer <br /> Tenant Mail Address City 1 State/Zip Phone <br /> i revPoG r7- I1 l opft 0 1200 co ilt, s,--s Et S'p 77`z e (.r/,49Y10 <br /> Electrical Contractor Mail Address V City State/Zip Phone <br /> F--1160,ae. es3zi)2J-..,s - --rc:24"60 <br /> fyi <br /> State License Number Contract Price of Work` <br /> fr\e ee 0C.tvce- QC3v C.“ L 62(V-03� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: Ad '/z..I A-i''1 1/1' ef 1 eh cr 4 it3e-,641 <br /> va,,,f,,,, , A--bo ccv) teov a eect IT (42- 6 47 varr-e.t____. <br /> 4Di c7 00N6ce rr /Z j4> (h&&, S .. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105if <br /> 0() <br /> I hereby certify that 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 PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction orthe <br /> performance of construction. That I am authorized by the owner of this property to perform the E 130 [ - 12-2) <br /> work for which appli,:tion is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 W' f. <br /> /il <br /> /% —/3 ^// <br /> Sigrid"r- Date <br /> REVISED 3/20/13 <br />