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—�- ------ <br /> I -- - — __ _ . _._ <br /> - ---- <br /> ELECTf�ICAL PERMIT APPLICATION j <br /> � CITY OF EVERETT PERMIT SERVICES � <br /> I 3200 CEDAR STREET, EVERETT, WA 982C1 <br /> � 425-257-8810 - FAX 425-257-8857 -www everettwa.org <br /> � <br /> I <br /> i oZ//.T f'G c.(:2 rlvz <br /> 'i PROJECT ADDRESS <br /> � � / / (' q <br /> jrAteft'S c��' /P r�e•�{�aJ �J�' ,ra o� /�9�14e �rT� JG w /�G fi41' (�l�1 Y'f�9o3 <br /> O�vner � fAad Atldress Ci;y State/Z�p Phone <br /> i <br /> s'he ��,. W %/uv�s a��t" �ac��;c' /l"-� �Etf r,vp <br /> � 7Cnanl MaitAddress City StalelZ�p Pt+one <br /> �-; kc. <br /> L� �r £�e�-� -� k�� �-coLl �&o`�" rlvv �u� 1'��,.�.c�, w;f 96-�sz �(.�s �`�- ya�L <br /> ElecVical CoNraGlor tda�i AtlOress Cny State2rp Phone <br /> �[ <br /> L„�a'�e, �y2G�� sao — <br /> Slate Ucense Number CoNract Price of Work <br /> � Proposed Use ot Building Contact Person (Plan Rewew) <br /> � <br /> Square Footage Qf residenbal new construchon, remodel or addition) �I <br /> II <br /> i Number of devites(If low voltage) II <br /> � <br /> L'escriplwnofWorkloHeDone�. ��`�u' � P ���Scn�i�«� r�i�nr'r GFC / aq(� CGaNnI �. C•0 . __ I <br /> -, —�'_ I <br /> � <br /> i <br /> ---- --- —_. � I <br /> FEE <br /> i <br /> CITY OF EVERET7 LOCAL SALES TAX CODE IS 1105 � � �� � i <br /> I he�ehy ceridy fhaf I have read and examined fhis application�nd kno�v fhe same!o be(rue and _� •, <br /> con�ct �^�I provisions ollaws and ord�nances govemirtg thrs lype ot�,,,�:�.:'.'!!•e complefed � <br /> n�helherspecrlied herein ornof. The qranhng ol a pemid does not presume In givc authonf}�fo P[RMR� I <br /> Iviolafe or cancel the prov�sions ol any olher s(ate or local law regulating cons6uchon or the E i � � � - a �g <br /> peAomiance ol consWcbon That 1 am aufhonzed Gy fhe ouvier ol this property fo pedomi the �I <br /> �vori�/or which applrcalron is made and I comply wi(h fhe Sfafe Conlractors Law f 8 27 RCW and <br /> 296.200 WAC. <br /> a�..� ,� � ,s ' <br /> Signature" Dat <br /> � <br /> ` _'-��-F'--n�'�_ - -----_. ---' ----- -�- -----I <br />