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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 /> 19 <br /> 1 <br /> p /CO 'Ph Sr g am; <br /> PROJECT ADDRESS <br /> S E N(b g Cb vA ve V rry NeAC,-µ /005- ADert$4V ST. S e e rr-e a G//49E/0 <br /> Owner Mail Address City State/Zip Phone <br /> SEN PM;AR ( 'or ptuwwf /Ie 1920 /061-1‘' Sr S a &tie&e77, WA <br /> Tenant Mail Address City State/Zip Phone <br /> (sy- —f3) y75-3/2ozv2 <br /> Al aii oPot !TAN EcTa-riz,,e pcL CO /200 Se 14-iu cCO STS Sp477le-1 Ur✓4 8/0 8 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> nc. TR o — c 8 9' 3-- s--- /) 000 <br /> State License Number Contract Price of Work <br /> R o N (a fzc. eo6-2oo-O3 z <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: A au' --t-w0 /500 W'P'Tt S'TirP iti4--e/I.S <br /> 0 se (N) �- l�A--�eoc /1t <br /> e Vie_ r N L.Ar-g <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 72 - <br /> 1 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 or the- ) - <br /> performance'of construction. That lam authorized by the owner of this property to perform the E 1 3 1. 0 �;- <br /> work_for Which'application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296;200 WAC:. ._- <br /> �dr..�ja _ <br /> x__ <br /> Signature Date <br /> REVISED 3/20/13 <br />