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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 /> �'��(—�C: , — Q <br /> �O ,( 1 <br /> PROJECT ADDRESS � � %'�`�U� <br /> �;��� P , � � ����-�ir��t .�� ,���r/ ��' 31�- ��� <br /> Owner / <br /> Mail Address City StalelZip I <br /> �j�r� � 'f / �1 R ./�D � <br /> �J �v O /O� c- �'�'�/�CZiE' �'£�a.7 ��4, % v'�i " "7 (/��t /�OF ����(�' � <br /> Tenant Mail Address <br /> C�ry Slate2ip Phone <br /> L' • : 1 �' , a=`� ,r�n y/_�C� i�{vsc� <br /> � Cit Sl�le2ip Phone <br /> E�ectricalConiractor MailAddress Y d� � <br /> � n �/ � /�l01� � v <br /> �(�y, , � 'r �� � /�� J '"' Contract Price of Work <br /> Stale License Numbef <br /> ( <br /> ��f�/,F' / � J 'f' /pt7 !C� <br /> Proposed Us of Building Contact Person (Plan Review) <br /> ,�a1f�v1eS �'��S <br /> ;quare Footage (If residential new conslruction, remodel or addilion) <br /> Number of devices(If low voilage) n <br /> Description of Wark to Be Done: � -�� �" '" /1 <br />� v i�2.� i� 1i�,�, �� n ��� L - - <br /> / <br /> � FEE i <br /> ,�� c� � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> 1 hereby certi(y that 1 have read and examined this application and know the same 'ro be true and <br /> correct. All provisions of laws and ordinances goveming this rype of work v�ill6e completed <br /> whetherspeci�ed herein ornot. The granting of a permif does not presume to give authority lo PERMIT# <br /> violate orcancel the provisions o/any otherstate orlocallaw regulating construction orthe E� � � � -_ 2 J� <br /> performance of ccnstructior,. That I ari aufhorized by the owner of this property to peAonn the <br /> ' work(or which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> `" ,n�' e " id -:�a- l 3 <br /> � ,Ct� _ <br /> Signature Date <br /> � <br /> r.evisEo 3rza�s <br />