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ELECTI�tCAL. PERIV�IT APPLICATIQN <br />C�TY QF EVERETT PERMIT SERVIGES <br />3200 C�DAR STRE�T, EVERETT, WA gg201 <br />425-257-8810 - FAX 425-257�88�7 — www,everettwa.org <br />� D��._ �� �� w <br />PROJEGT AbpRESS <br />n Q. r'i -1-� � t,� m <br />owner � 3`�0. ��a� <br />MaiJ /�dciress Ciry State/Zip Phona <br />TenanT <br />EIaCtCi�al Contractor <br />.l� <br />State Lfcense Number (requiredj <br />PropOsed USe of pullding <br />Mail Address <br />city <br />'{ 0� s i3�i"r� N� <br />Mail AddrOss ci}y <br />Square Foptage (ff f�sido�ltial naw ConsfruCticin, rempde! or adCllfion) <br />Number o� devices (!f low voltage} <br />Des'ription of Wa�k to ee Dona� �c�L�-1 I �� (yC�� <br />CITY OF EVERETT LOGAL SqLES TN( GODE IS 31U5 <br />State/Zip <br />Siate/Ztp <br />Phone <br />i'hone <br />O�a 30 <br />Clty of �verett �us�ness Licen5e NUmber (rsquired) <br />Y�P � � <br />Coniract Price of Work <br />4��`Yl' L �o� • a��•�Ob <br />Cor�t2��# Pers r�/Contact Nirmber/Email <br />! hereby cortify that! ilave ro�d end cxamined this application and know the seme to he frue snd <br />correct, A11 provisr'ons oflaws and ordinances governing this type of v✓ork wi!! he completed <br />whethor specified herein or not. Tl�e grsnling of's permif does nof presume fo give authority to <br />violHte or cancel the provisions of any other state pr /Oca! law rgyulatiny conslrUCtion or ihe <br />pelformanca Of construction. That ! air� al�thorizod �y the owner pf this prop8rty to perforrr> the <br />work fnr which appliCation rs ni�de and I Gomply with the Sfate Contractors Law 18.27 RCW �n0 <br />'��.20o w,qc. <br />)��0 <br />F��lSED OIIi�Jfi/20va <br />-� � <br />FEE <br />�O d6 <br />PERMTT# <br />� C�l� l�� <br />.o <br />