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ELECTRICAL PERIVIIT APPLIC�►TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�6Da Gj� � �i� � i <br />PRG�JECT ADDRESS <br />Owner <br />Mail Atldress <br />Gty <br />StatelLp <br />Phone <br />��oo �o�p� s� fio��� �r//�- g5fzc7/ <br />Tenan� Mall Address Ciry Slale/Zip Phone <br />�� - /���� lSG- <br />Elechical Conlraclor Ma�l Address Ciry Slate/Zip Phone <br />� <br />/�I�%/!L /��- S�'/ �(r � ��D� �- <br />State License Number CoNrad Price of Work <br />♦ <br />s�..,o� y,��- s�� � <br />Pioposed Use oi Building <br />Square Footage (I( residential new construclion, remodel or addltion) <br />Number of devices (If low voltage) <br />Descnplion of Wo�k lo Be Done: <br />ol. <br />s <br />CITY OF I=VERETT LOCAL SALES TAX CODE IS 3105 <br />// <br />Contact Person (Plan Review) <br />I hernby cerldy fhat 1 have read and examined fhis application and know Uie same fo be true and <br />correcf. All provisions ollaws and ordinances goveming (his f ype ol work wifl be complefed <br />�ti�hefher specificd herein or noL The gronting ol a permit does not presume to give aulhonty to <br />violafe or cancel lhe provisions o/any ofherslafe orlocal law mgulating constrticfion or the <br />peAomiance oI conslrucfion. Thal I am aufhonzed by the owner o/thi; property to perfortn the <br />w.ork lor w�iich application is made and I comply wilh the Sfate Confracfors Law 18 27 ftGW and <br />NE1'�SFDYtNiJ <br />�1L <br />FEE � <br />��Z��' � <br />PERMIT� <br />E1�05 -03 <br />