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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi, WA 9820� <br /> 425-257-8810 - FAX 425-257-8857 - www.everethva.org <br /> � <br /> s _c�-/S <br /> �''�// ,��, �/ 5 T <br /> ��s�s� y I <br /> PROJECT ADDRESS <br /> Owner MailACdress City State2ip Phone <br /> Tenant MailAddress Ciry Slate2ip Phone <br /> / 3�a <br /> � 5 �/.t 'f,ric {'�J ��f7 Mdr�.SU,��P W� `�iZ7�'7 C-759-13l0/ <br /> I Electncal ConlraMor Mail Address Cit Slate2ip Phone <br /> `P 4�C�� F� �z C'g �. �-3 � y S 5 <br /> State License Number(required) Ciry of Everetl Business License Number(required) <br /> (�$ O� <br /> e <br /> Proposed Use of Building Contrad Price of Work <br /> �y� �'t�Zs-z�o�- � I �j <br /> Square Foolage(If residential new construction,remodel or addilion) Contacl Person/Contact Number/Email <br /> Number of devices(I(low voltage) <br /> Descriptian o(Work to Be Done: ���il/i �J7Tt.a-+'t� � I i G L�`� <br /> FEE <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 �� G G� <br /> 1 hemby certily fhat 1 have rend ond examined this application and know fhe same ta be true nnd / ` <br /> cormrf. All provisions ollaws and ordinances goveming fhis rype ol work will be comp/eled <br /> �vhetherspedfied herein ornoL The granting ol a pemnt does not pmsume fo givc aufhonly to PERP1ITk <br /> violafe orcancel the provisions ol any otherslafe or locallaw regulating consfruction or fhe I' <br /> peAonnance o/conslruction. That I am avfhonzed by the o�vner ol fhis properiy fo pedomr fhe E (�D 5 � D y� I <br /> wodr/or which application is made and 1 compty wilh(he State Contracfors Law 18.27 RCW and � <br /> 296.200 WAC. <br /> J� - — � s <br /> SignaWre �ate <br /> FrvisF�aenYzm+ <br />