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r` oz �a,�� <br /> .. ; <br /> � ELECTRICAL PERMIT APPLICATI�ON <br /> CITY 4F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> �Y�12�7T�PS � �V'�R�n�N�4•CoV <br /> _ �� �J=/z � <br /> PROJECT ADDRESS <br /> ,�,��c�''� �o.�vx 3707 �'�� w�' gf�/2�2Zo7 -�Z�• 3�Z•z�� / <br /> Owner Mail Address Clty SiatelZip Phone <br /> t.. <br /> Tenanf Mail Address CRy State/Zip Phone <br /> /�i�1���a/D�� �v,�X��77���,��f�Z75 �2�29���f� <br /> Electrical Contractor Maii Address City StatelZip Phone <br /> �'�i�'�G 9 B�v�. O`�05�� <br /> State License Number(required) City of Everett 8usiness License Number(required) <br /> a��oa <br /> Proposed Use of Building Contract Price of Work <br /> k'��ei.l��m�n�� ��w�T c� <br /> Square Footage(If residential new construction,remodel or addition) Contact PersonlContact Number/Email <br /> �� Number of devices(If low voltage) <br /> Description of Work to Be Done: ������%�- -T v <br /> .��p�,��,.��o�.,� <br /> . . <br /> FEE, <br /> CITY QF EVE�ETT I,OCAL SALES TAX CODE IS 3105 9��/�� Oc7 <br /> �f� <br /> 1 hereby certify that I have read and examinad this applicafion and know the same to be true and <br /> cor�ect. All provisions of laws and ordinances goveming this fype of work will be complefed <br /> whether specified herein or not. The granfing of a permit does nof presume to give authorify to PERMIT# <br /> violate or cancel the provisions of any ofher state or local law regulating consfruction or the � /� � i/'w /_ <br /> performance of consfruction. Thaf 1 am authorized by fhe ownar of this property to perform fhe ( Yi�O <br /> work for which application is made and I comply with the Stafe Contracfors L.aw 18.27 RCW and <br /> 296.200 WAC., • <br /> � <br /> • � �� . _.( <br /> gnalure Dale � - <br /> J�v�P�Q-C� /Y'(G���t� GENERAL CONSTRUCTION COMP.ANY <br /> REVlSED 08/06/2014 P.O.BOX 46-MLTI�ILTEO,WA 98275 <br /> �'/� G � 425-294-6944-PAX-425-294-6947 <br />