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<br />EL�CTRICAL I�ERMIT APPLICATION
<br />CITY OF E�l'ERETT PERMIT SERVICES
<br />:��oo c�oA� s�r����r, �v�e���r�r, wA ��;�a�
<br />425-257-881 Q- FAX 425-257-£3857 — www.everettwa.gov
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<br />PROJECT ADDRESS
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<br />�W(lE.'f � Mail Adclrt ;;5 Cit St<�te/Zip Phoriu
<br />Tenant
<br />Mail Acfdress
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<br />Electrical Contractor Mail Add'ress City
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<br />State License Nurriber (required)
<br />Proposed Use of Building
<br />Square Footage (If residential new construction, remodel or �ddition)
<br />Number of devices (If low voltage)
<br />� L�escription of Work to Be Done: ��'�-1; `
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<br />State!Zip Phone
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<br />State/Zip Phone.
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<br />City ot �verett Business License Number (required)
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<br />Contract Price of Work -� ��__ ���,t,�,�, �, ��:'Lt, ; j, r�'.;
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<br />Contact Person/Contact Number/Email
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<br />CITY OF EVERETi LdCP,L SALES 7AX CODE IS 3105 ��.�%�
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<br />! herehy certrfy thaf I have reacl and examineci this applrcatrnn and know the same to b� true and
<br />carrect. Al/ provisions of laws and ordinances governing this type of work wil! be r,ompteted
<br />whether sper,ificd hcrein or not. Thc granting of �a pe;rrnrt dacs not presumc to grve authority to PERMIT# '
<br />violate or cai�c,el the provisions o( any c>ther' slate or loc,��f law regulating construction or the � ��
<br />perf�arrnance of construction. That I am authorize�l by the owner oi tl�us proF,�erty to perforrr� the ����_ ��� �
<br />wnrk for which application is made �n�i I cornply with tl��e State Contractors Law 18.27 RCW and i
<br />296.200 WAC. I
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