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ELEC`TRICAl� PERMIT APpLICATiON <br />CiTY OF EVERETT PERIUIIT SERVICES <br />3Z00 CEDAR ST�t�ET, EVEREiT, WA 98201 <br />�25-257-8810 - FAX 42�-257-8857 � www-everettwa.org <br />�. ;� f � <br />PROJECT ADDI�ESS <br />Owner <br />�/{sil Address <br />�, ��5 � -z�� a�� <br />. �iV � �—t�� <br />stete�z�p Phone <br />Tenant Mail Address City StdtelZip Phr�ne <br />� L�.-� r�i � l 01 � 13�1-� I�� � l.��a Q'�l � t� ? � <br />EieCtt'iC�l Cant�aCtor Mail Address Gry StatelZip Phone <br />�w � �� <br />State L"scense NUmber (r8quired) <br />/ G � �'�. <br />Propos se of F3uilding <br />Square Footage (lf rssidentlal nsw construction, remodel or additio��) <br />� <br />Nu��of devices (If low voltage) <br />DQscription of Work to ge Done; <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />O � 3� <br />City of Everett Business License #Vumber (required} <br />`/� � w _ <br />Contract PriCe of Work <br />Contact PersonlCoi�#act Nurnberl�mail <br />( heleby certify that 1 have read and eXamined fhis ap,olication and knoW the sams to be true snd <br />correct. Al� provrsfans oflaws and ordlnances governing fhis type of w�rk will be completed <br />whefher spec(fied herein or not. The grarrting of a permif does nof presume ib give aufhority to <br />violate o� Cenc¢1 the provisions of any oti�sr siafe or local !aw rsgulefing construction 4r ths <br />perforntanGe of conSt�UGtion. Tf�ai ! am aufhorized by the Owner of ihis proparty to psrform the <br />work for which applicatron rs made and 1 comply with tha 5tat� contractors Law ?8.27 RCW and <br />'�9is.200 WAC. <br />%� <br />Rews�o osroerzo�e <br />FEE <br />��� �'o <br />PERMIT# <br />E ' ���""" ��L� <br />