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ELECTRICAL PERMIT APPLICATION <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />/ <br />Eleclrical Con ac� ~ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR[ET, EVERETT, UVA 98201 <br />425-257-8810 - FAX 425-257-8857 - wnv�v.everettwa.org <br />r� �� I�y <br />� MCzr ; �"e U ��i��" �� � g ��-s <br />Atail Adtlress <br />A7ail Address <br />Atail Address <br />� � ��d �_� 9 s-� ���C <br />State License Numbcr (required) <br />� <br />ProposeJ U�c of Duildin� <br />City <br />City <br />s� s 3o i�� <br />C dy <br />Square Pootage Qf residential new constructior, remodel or addition) <br />Sta+,elZip <br />Slate2ip <br />w'�,s«�� <br />s �� <br />o� C� ����.b�s! <br />i <br />� <br />Phone <br />�� � Phone <br />�J <br />� �3��r3r� <br />Phcne <br />Q�� �� �� <br />City of Everett B�siness License �Vumber (reqwred) <br />� ��� �� _ .— _— --- --- <br />Centrac� Price o('r:oik <br />���w y�_s��3t_�3l � <br />Contad crsonlContad Num6euEmad <br />Number o( devices Qf low vollage) <br />Description of Work lo Qe Done: ���- C� S� � W ��{ �� ` <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />� <br />1 hereby certify tl�at 1 have read and exarrtined fhis applic�tron and kno�v the same to he tn�e and <br />conecL Allprovisions oflaws and ordinances goveming this fype olwork �viil6e cornplefed <br />�vhetherspecified herein or nof. The granting of a pemiit does not piesume fo yive aulhonty fo <br />viola(e orcancel fhe provisions of any o(her slale orlocal la�v regulaling consfrucfion or fhe <br />pertonrrence o(construclien. That I am au(horized by the o�tinerollhis pmperty to pedomi the <br />work (or �vhich applicatron is madc and I compty r:ith fhc Sta(e Conlractors La�v l827 RCW and <br />296200 WAC. �� n <br />FEE <br />5�50 <br />PERh11T� <br />E15c��-17� <br />