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Irnn� 041�"�2013 1J:42 =404 P .0021002 <br /> _- --- — ---------- _ _ __ _- - <br /> - <br /> � ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ! 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ' 425•257-8610 - FAX 425-257•8857 -www everettwa.org <br /> 4 —2'''�3 <br /> C ,.yp u_ia9 <br /> � , <br /> fC'- > �c ' �'���„ �� ��l C���; <-1/_r� rl ,- ,5:��, <br /> PROJECT ADDRESS <br /> Owner Mail Adtlrese City StaleZp Phone <br /> C� <br /> i'� <� � �J/'/i�y 1� �i:�'� r � � G�-� /� l�h��C�� <br /> Tenan� tidnil Add�ess Ciry SIaINZip Pho�w <br /> '�� FC��i -�,����5�(�1 F'S /cZi.Jc ' /l� /✓ri�-�' S�� ;1�� �'-,.���z«.� i;%�/ b <br /> [lectrical Conit3c o� rdetl ndaress C�ry Slaie2fp Phone <br /> � <br /> C,�'��� - �/Gz �— L- S '-� �� � �! �' �'•� — <br /> s/. � �ci S <br /> Stale License Numbei ConVect Pnce ot Work <br /> ,�Vc �� l�F �" <br /> Pro{wsed Use ol fiuildmg Contacl Person (Plan Review) <br /> i <br /> i <br /> SQunre footage pf residonhal new construction, remodel or adddion) <br /> / / r <br /> / ���� ..t��>; i,�_'/i ���11 1 ���/ � <br /> Number o dewces(f low vollage) i <br /> DescripUon of Work 10 Be Dono. F. P�/�=Y i Y `�� �� �' � "� `' � ' � ' — �� <br /> I <br /> � FEE <br /> �I GTV OF EVERETT LOCAL SALES TAX CODE IS J106 � <br /> II liomhy ceiUly fhaf l hove�ead and ernminod Ihis eFPLcnhon ond hnow the seme fo be fivo end � ,� �_ <br /> Icormcf All p�uvrsrons oll<iws antl orAvmnr.es govenrinN R�is fype ol work wdl be compinted — <br /> whedrer spenl�ed berein or not 7he gmnhng ol n pemuf Uoes not presume(o grve euthonty fo PERMITN <br /> � v�olnfe oi r,�ncnl fhx pmvisions aI nny nfher sfnto or lor.al law mpufefing con5 Wcfion or thc A <br /> iporfonnance ul consWchori Tliaf I am auf6onreA by fho ownor o/fhis p�operty fo peAomi fhe E I�U/�_ , lLy <br /> work/ni which aUF�rcofion is modo xnd I compty wifh the Sfefe Confrncfoi5 Law 1827 RCW end � � � __ <br /> � 196 20�9 WAC -� <br /> il ----'�".."�^'�, � � 7 ( " <br /> ' SignaWro ate <br /> � <br />