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Nov, 9. 201 � 3: 32PM
<br />No, 0783 P, 3
<br />ELECTRfCAL PERM�T APP�IC,A,TION
<br />C[TY OF EVERETT PERMIT S��VIC�S
<br />3200 CED,AR STRE�T, EVERETT, WA �8201
<br />425,257-8810 - FAX 425-257-8857 – www.�vereHwa.org
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<br />PROJEC7 AdtiR�SS
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<br />Ownor Malf Addross City Sfate/7ip Pi�ur3a
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<br />Mall Addrass
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<br />Ctrical Contractor -" Mail nddress t:il Staic/Zip f'ttone
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<br />S`ta�� Lfcense Nur��ber (required)
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<br />�roposed ilse of Ci«ildiizg
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<br />Squam Footage (if residentiaE new constriiction, remodel or acfditio��)
<br />Nulnber of dovicos (If [ow voltage)
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<br />Cfty of Everelt Business License Numb�r (r�quired)
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<br />Contract Price of Work
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<br />Con#act PersonlContact Number/Err7ail
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<br />Doscn tion of Wark #o �e Dorte' t,.�� � .. �, � ��L�- 2_"
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<br />CIiY OF EVERETT LOCAL. 8A��S TAX CODE IS 39ob
<br />I hcreby certify fftef ! h�ve r'ead a�tc1 ex�vnh7ed fl�is app(ir.afion �nd hnow the sarne [v be frue �ncf
<br />corrgct. AI! /�rnvisions nf l�ws and ordinsr,ees yoverr>Irl� ff�ls lype of work will 13e cnmpleftad
<br />whr.fher specified frereit� or noL Ti7e c�<<���ting of a pc�rmit d�r,s not presurrre to give nuff�orily lo
<br />Viol��fe o�� c��nce! tl�o pmvisions of sny other stsle ur' locRl law �e�ul�ti��c� c�tlsb�uction or fho
<br />performr�rrce of CUr�s(ruCl(ol�, Th�t ! am ��uthorizod by thr, ownrr of fhis proper�y to pe�(ottn (he
<br />work (or whic�� �p�1i,r.�tinn is made and ! comply wllh U�e Stafe Contr��ctors Law �18.27 f�CW and
<br />296.2UU WAC.
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<br />RCVlSED OtVOi✓1 U 14
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