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ELECTF�IC�►L. PERMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />`���J G O%,�i� lyL�.l <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical Coniractor <br />// `F• , rr c 91�.� Th <br />Stale License Number <br />Proposed Use of Building <br />Mail Address <br />MaA Ad4ress <br />Mail Address <br />Square Footage (It residential new construction, remodel or addition) <br />Num6er of devices (If low vollage) <br />�escription of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />P� <br />Cdy <br />Ciry <br />� <br />City <br />Stale2ip <br />Stcte/Zip <br />T ;,�� <br />StatelZip <br />.f�.�0� <br />Coniract Price of Work <br />Contacl Person (Plan Review) <br />�! <br />I hereby certify Ihaf ! have read and examined fhis application and know fho same to be true and <br />correcf. All provisions o( laivs and ordinances goveming this fype o/ work wi116o completod <br />�vhether speci�ed herein or noL The grenling ol a permit doe� not presum� fo give authonty fo <br />violate orcancel Uie provisions ol any ofherstate orlocal law regulating consWction or fho <br />per/om�ance ol construction. Thaf : am aufhonzed by tho owner o/ fhis prroperty to pedorm tho <br />uork lorwhich applicalion is mado and I compry wifh the State Con(ractors Law 18.27 RCW and <br />296.200 WAC. <br />� . t�{;FO � � u'I ] <br />Phone <br />Phcne <br />�d i <br />Phone <br />FEE <br />-� J ov <br />PERMIT# <br />E I 3( I-04 I <br />