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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.evereltwa.org <br />��i �Z �J mc�n (�,� ��+ l� -.o_ <br />PROJECTADDRESS <br />Ownef <br />Tenant <br />Mail Address <br />'�S <br />Mail Address <br />City <br />Ciry <br />Slate/Zip <br />State/Zip <br />Phone <br />rnone <br />�il�'lC.� GC.o �-%,� �LC_ 72� Nc�✓�.r,� `I�,¢� ,L �'�:�.Kc� lsl.i,�-. 3G� �Za <br />Eleclricai Coniractor Mail Addcess City Slate2�p Phone <br />/,��t2 �-�-� �C � n��s�l�� v� 3 3 7 c� <br />Slale license Number (required) City of Everett Business License Number (required) <br />�-ewi �v�u�! c�'� 1 <br />Proposed Use of Building <br />(t�� <br />Square Footage (If residentiat new cons!roction, remodel or adddwn) <br />Number of devices Q( low voltage) <br />Description of Work lo Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />—�4�a � r <br />Contract Price of Work <br />Contacl PersonlConlact NumbedEmail <br />1 hernby certdy that 1 have �ead and examined Ihis applica(ion and kno�v the same lo be 6ue and <br />correcl. All provisions o(laws and ordinances goveming fhis type olworlc n�ill be completed <br />�vhefher specified herein or noL The granfing o! a permit does nol presume (o �ivc aufhonfy lo <br />violate orcancel fhe provisions ol any othersfafe orfocal law regu/afing consWcfion or the <br />performance af �onsfruction. That! ai,i authonz by the owncro/thrs property to perfomi fhe <br />work lor�vhrch app(ication is made and 1 comply vith the Sfate Confraclors La�v 18.27 RCW and <br />� <br />revrsea oan2ao ia <br />FEE <br />� _I�� <br />l � - <br />PEkMITri <br />E(�Iz- p2z <br />�D <br />