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• <br />• <br />ELECTRICAL PERMIT APPLICATIOIV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />2 Z Z. � O /�-1�� �-v-c... <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Address <br />Mail Address <br />City <br />C ity <br />��o/ �'ZS- l,23• �Sz2 <br />State/Zip Phone <br />State/Zip Phone <br />�� � fs/� �lr.� �0 8a,r z t�71� NIo ��. f �/.�f.�� � l�? 7� <br />Electfical Contractof Mail Address City State/Zip Phone <br />� � Z�'�'.� ��-C� u � N T�-,�,� f'�?l <br />State License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />,� . s'o v <br />Contract ice of Work <br />�(' �•h �t�t �s d►� <br />Contact Person (Plan Review) <br />Description of Work to Be Done: �b ��/� Z� �cG y�,r.`L �L3�,� e,4� /�i/'e.�.�-er' <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined fhis application and know the same to be frue and <br />correct. All provisions of laws and ordrnances governing thrs type of work will be completed <br />wheiher specified herein or not. The grantrng of a permit does not presume to give authority fo <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construcfion. That I am auihorized by ihe owner of this property to perform tl�e <br />work for which application is made and 1 comply with the State Contracfors Law 18,27 RCW and <br />296.200 WAC. <br />nature Date <br />/l <br />FEE <br />5��' <br />PERMIT# <br />E I �{�?� �- ���;� <br />