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ELEC�'RICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 - FAX 425-257-8857 — www everettv+a.org <br />��05 �r. <br />PROJEt:T ADDRESS <br />II �Q { � E <br />Owncr <br />i U, c�t <br />� 7enant <br />� <br />I ��� �� MP �. <br />Etectrical CoMrac�or <br />Pdan Address <br />1.1ad Atltlress <br />htaii Atltlress <br />� 1i3�5Jn'1 �$oL '� - <br />State License Number (required) <br />I'--C'S c� P+�Y- "(� 1 <br />Proposed Use of Dwldmy <br />Square Foolage pf residential new cm�siruclion, remodel or addilion) <br />Number of devices (If low voltage) <br />Description of `Nork to �c Done. <br />CM1y <br />Gty <br />Gly <br />StatelZ�p <br />S�ate2ip <br />Stale�7_�p <br />Phone <br />PhOn^ <br />Gry of Everelt Business License Number (requned) <br />�-�Z:�`�_"_-- <br />�dntracl Pnce cf Work � <br />Contacl Person�Conlact Numbed[ma�l <br />f.t��:_�_.��---- <br />FEE---..----- I <br />CITY �F EVERETT LOCAL SALES TAX CODE IS 3105 �f� � I <br />I hereby cerGly fhat l lrave read and r,xamined fhis applicafion and kno�t� the same fo 6e frue and � <br />correcL All prov;sions ollaws and orclinances goveming Uris f,pe o/ u�oik �:ill he completed � <br />�vhefher speci(ed bmcin or nof. Thc granling o/ a penmf Aoes not prosumc to givc authonty to p[RP1IT•7 �,, <br />viol, le or cancel fhe piovisions o! any oflier sfate or � cal Imv �egulalin�� o�sl �cGa�t or Ibe �/��0 ^/�� i <br />pr,rlomiance ol consfrucfion. 7hat I am authonzed 6 fhe owner o/ thrs ro ert to c-Aonn Ihe <br />�vu�k lor �vhich applicafion is made and I comply rifh fhe Sfate Confncfors Lnw 18.27 RCW �nd — � <br />296.200.WAC. ^ � � <br />\ <br />I <br />I <br />-- �-- --- -- _ ._J <br />