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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEOAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX425-257-8857—www.everettwa.org <br />%�b �o�YA.� �r�c <br />PROJECT AD ESS <br />�-0 �—!� <br />G— ►�65—D(„(o <br />Ma�-�r.aw AW+ra �16 C�I1� �� �,���+� wl� �'s�z�► <br />Owner Mail Addmu Cify SlatrlLp Phone <br />Tenant <br />owne-�' <br />Electncal Conhador <br />State license Number <br />�es;���� �D� <br />Proposed Use ol Building <br />Mail Add'ess <br />Mail Address <br />Square Footage (If residential new consWdion, remodel or addition) <br />Number of devlces (If low vollage) <br />Descripfion of Work to Be Done: <br />Cay <br />Ciry <br />Slale/Lp <br />SlalcfLp <br />ConUact Pnce o( Work <br />Contad Person (P�an Review) <br />l.l✓1�Y Fho� � ��lal ZuV1� �'I[ac�l. �WSN au� C�� b/tnkp✓5 <br />�� nw �oA�p. <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />I hr.,�rhy ceAily Ihuf 1 bave ir.ad and �txaminr,d fhis applicafion and know 1hn samrr lo be frue and <br />correc(. All provisions ollaws and ordinances govr.ming Ihis lype ol work will 6e completed <br />whether spec�r,d heicin or noL Thr, gnnfin� oI a permil Aces nof pmsumr, !o givn aulhonty fo <br />violafe or c»ncel fhe provisions ol any other stnfe or locnl law reg�dnling consWciion or the <br />pednrrnance ol consfiudion. 17ia1 I am au�honzed by fhe owner ollhis property lo pedorm Ihc <br />work lor which applicahon is modc and I comply with fhe Slafc Confractors Law 18.27 RCW and <br />296.T00 WAG. <br />`��l:�'� <br />�-��,:�,��,� <br />,s ;� -���y <br />Phone <br />Phone <br />fio�n <br />FEE <br />� �� <br />PERMiT# <br />Eli —alc� <br />