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r— <br />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.everettwa.org <br />�C 3�3 f�Us� �� GJ1�� w� G�,��^ <br />PROJECT ADDRESS <br />O�vner <br />Tenanl <br />• Mail Atldress <br />Mail Address <br />Ciry <br />City <br />y�s <br />�s, <br />���e�� U�: <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />�A�!n;�c s�.t �� ���� i�� � Q�aa� <br />[lectrical Contractor Mail Addross Ciry Slate/Zip Phone <br />�i:.cs ��y2v� <br />Sta�e License IJum6er <br />'� �/� '7 N/ �c.�G:s <br />, Proposed Use o( Building <br />i Square Footage pf residenlial new construction, remodel or addi�ior� <br />Number of devices (If low vol�age) <br />� <br />nco <br />Contrac Price of Work <br />Contact Person (Plan Review) <br />Description of Work to ae Done: ��)L�+ �� o` �l �� LL 4L�� �������5 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heieGy certi/y that I have read and examined fhis application and know Ihe same lo be true and <br />conect. All provisions of la�vs and ordinances goveming fhis type of �vork will be complefed <br />�vhefherspecilied herein ornot. The grantir.g o(�i pemiit does notpresume to give authonty to <br />✓iolafe or cancel fhe provisions of any ofherstate orlocal la�v regulating consWctien orthe <br />perlonnance ol constn�ction. That 1 am authonzed by the o�vnero( this property to peAorm (he <br />,� oiic lor rohich ap,J�licafion is made and I compty �vith the State Confracfors Law 18.27 RCW and <br />?96200 WAC�// ' <br />� <br />FEE <br />7� �S� <br />PERMIT# <br />E I �o �-1 Z9 <br />