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� <br />� <br />ELECTRICAL PERMIT APPLrCATIQN <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE�T, EVERETT, WA 98209 <br />425-257-881 p- FAX 425-257-8857 — www.everetfwa.org <br />3`� SS a u 5-�- <br />PROJECT ADpR�SS <br />+ ��, ,� <br />Owner <br />Tenant <br />� � <br />EleCtrical GontraCtor <br />State License Number (requ�.� <br />Proposed uSe f�))�ing <br />'� 1 S o �` <br />Mail Address <br />Mail Address <br />Mail Adtlress <br />c�ty <br />City <br />� <br />eity <br />Square �ootage (If rasidential new construction, remodel or addEtronj <br />Number of devices (If low voltag�) <br />Description of Work to Be Done: � l `� � �Ob <br />CITY OF EVERE7T �OCA� SAL�S TAX GODE 13 3705 <br />�a��32�•��- <br />StatelZi� F'hone <br />Stake/Zip Phons <br />� • . <br />• "� ..�_ r �'I <br />_- . � <br />t� � 3 n . <br />Glty of �Verett gusiness LlCense NUmber (required) <br />Y.G .� � <br />Cont�act Price of Work <br />Olo.��'g. � Oo <br />Contact PersonlContact Number/�mai! <br />� u �1 v �� ..�s ,� <br />l hereby cortify tha� ! have read and examined tilis applicafron �nd know the same to bs true and <br />correct, A!/ prnvlsions of lavrs and ordin�nces yaverr�ing this type of work w!/1 be co�npletsd <br />V�hether specifie�! `��rEir7 or not. The yrarzfing p{ g�ermit dOeS not presumo fo grve aufhonty to <br />violate or car7eel the provrsions of any otiier st�te Or /oca/ law reyulafing constructipn or fhs <br />perfofrnance Of caTstruction, That l sm authorized by the own�rOf this property to perform (f7e <br />work for whrch appiiCatior� is ma�g anr� I Comply with tH@ Ststs Contractors Laiv 18.271iCW and <br />9�.200 WAC. <br />re <br />REV7SED OFMOf.120 f 4 <br />a��. <br />F�E <br />� �6°� � <br />PE{2MIT# <br />E1�1�.-�?� <br />