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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STRE�T, EVERrTT, WA 98201 s_aa_►3 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org E/�� �3I <br />' �;��ll- ll''� � ��;-( <, � <br />PROJECT ADDRESS <br />'%_'/�,,,_ 1��1,6 1 11 a., SJ S�: <'vr�.2u�� w r? �� _ <br />Ownef MailAddiess Cdy SlatelZip Phone <br />Tenant <br />Mad Address <br />� � L <br />City <br />Stale2ip <br />Pnone <br />�, <br />�� ur � �t:_.ii_ � � � � �z:�x � � � _ � l �V� J���S <br />Eledrical Conir�ctor Mad Address —�� ��� Slate/Zip Phone <br />� � t'Ct�V12`r <br />Stale Lic�er <br />Proposed Use a( Building <br />I Square Footage (II residenlial new construction, remodel or addition) <br />Number ot devices (II low voltage) <br />Contrar.t price of Work <br />Conlact Person (Plan Review) <br />� <br />Oescriplion ol Work lo He Done�. r^ o�i+��t.� '�1 i�� wLl�l1 -�'��-� — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 iiemby ceihly Nr<rt I 6nve rend and exnmined this npplicafion nnd know fhe snme fo be tn�e nnA <br />r,onecL All pmvrsions o/ laws and onlinances yoveming Ihis type o/ �vodc �vill ho cornplefod <br />�vhethr,r spe�nhed heruin ornof Tho yranfing o/n penrrif does not presumo fu give nuthonty to <br />�iolefe or cnncel fhe provisions ol nny ofher sfnto or local low �e9ulafing cansfn�cfion or the <br />porfurnronce ol constniclion Thnf I am nufhonzed by Ilre owner o/this propeRy fo perfoan fhe <br />work lor wluclt applrcation is made and 1 compty wifh fhe Slefe Confracfors �aw 78.27 RCW and <br />296.200 WAC. <br />_,,� .�- L��:'� � �3 <br />�,',^»�'' �;',lt_� J - <br />3�-- iyna�ura —T� —.—"'— DBIB <br />FEE <br />, ��-n� <br />PERMIT# <br />E�%�;5-i�l <br />