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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIC(=S <br /> 3200 CEDAR STREET, EVERETT, WA 982G1 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> � �I�I��� � <br /> �b 7 <br /> rj G-1�II—!.S'/ <br /> 21 C���uree� ��U <br /> PROJECiADDRESS <br /> Owner Mail Address City State/Zip Phonc <br /> �c�t ��ein�fi 5�� 1 C�efqtQer� CJf}V Eu�r�t� / lA- .20 <br /> T2nanl MailAddress City State2ip Phone <br /> �).�c'�}-�,we�� Cc�i�✓� 14�-� ItiisrP( ti!� ��o , � �P �� Q8D72 �115806-9za� <br /> ElectricalConlractor MailAddress City Stale2ip Phone <br /> I�o�kti Ei 9 83 R� D S C�6 9 q <br /> State License Number(required) City of Everetl Business License Number(required) <br /> .5�n CP � �e"�o,1 � _ � ��O O <br /> Proposed Jse o(6uilding Conlract Price of Work <br /> 0% Q>��n� �1.75-35�( - 061Q <br /> Square Footage(I(resideMial new conslruclion, remodel or addition) Contact Person/Conlacl NumbedEmail <br /> Number of devices (If low vollage) <br /> Descriplion of Work b Be Done: r"I �� I ��� ���� � �G�� 1 �O (' _ <br /> �1 d�r e� _ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CC�E IS 3105 � � -�D <br /> I hereby certi/y(haf I have read and examined this applicalion and know fhe same to 6e(rue and <br /> correcf. All provisions ollaws and ordinanr.es goveming Ihrs type o/work will be cornpleted <br /> whelherspeci/ied he�cin ornol. The granfing o/a pemiil does not pmsumc(o give au(I�orify lo PERMITO7 <br /> violafe or cancel Ihe piovisions oI any o(her state or local law regulaling cons(ruc(ion or the <br /> performance o/cons ction. That I am aufhonzed by(he owner o/lhis properiy lo peAonn the E i(a�r J .� �s <br /> �vork lor whi ap �afion is maUe and I comply wilh Ihe Sfate Conlractors Law 18.27 RCW and <br /> 29G.200 W �� <br /> ' �I /�- /� <br /> Si9nature Datc <br /> nFv�sFn oe�nr✓to ra <br />