Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />L 30 9 P,v..,rq ru� �,vaN r,� Q, T G <br />PROJECT ADDRESS <br />Owncr <br />Mail Addrtss <br />fdail Add�ess <br />Sl <br />Ci�y <br />!o-an_ �y <br />C l� Ic� I 0-o� <br />;,� 4 %0�7 <br />StalrJZip Phone <br />� a � 8'Z.o hL <br />Statc/Zip Phone <br />sal�< �ler�v�`L7r�� .1112,y_yas�-SF. S�,�,o�(sln ��9�a90 4is335ia�S <br />Eleclncai Con�raClOr Mail Addrt;ss Ciry StateJZip P�one <br />Sot',s � i gqaPB <br />Slate Gcense Number (required) � <br />RE,�'4; � <br />Proposed Use of Budding <br />Squaro Footage (If residenlial new consirvclion, remodel or addilion) <br />30 <br />Numher of devices (If low vollage) <br />Descnpfion olWork lo Be Done: W� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />CL� <br />City of Everetl Business Licensc Number (required) <br />� �o� o� <br />Contracl Pnce of Work <br />,Toc,� S�1ia �{s�,S 344 I�>� <br />Conlacl PersoNConlacl NumbedEmail <br />I hemby cedily Ihaf ! havo read �nd examineA fhis appGcalion antl know fhe samo fo Dn fruo and <br />correcL All provisions ollaws and ortlinances govr.ming fhis type o/ woAc will Ae complelr,d <br />whelfier specified he2in or noL Thc gn. nfing o! a pemiil dxs no! presunre lo givo aulhonty to <br />viola(e nr cancel fhe provisions o/any olher stale or local law /egufab'ng consWclion or the <br />peAonnance o/ consfnic(ion. Thal I am aulhanzed Ay (he owner o/ lhis propeAy lo pedom� fhe <br />work for which applicafion is made and 1 comply wilh fhe Sfafe Confractors Law 1827 RCW and <br />2�6.200 WAC. <br />� ,��..: !° )� I �Y <br />REVfSf�Pb06'1Y11� <br />FEE � <br />I� ° <br />PERMIT# <br />E ��`��l��Dlg <br />