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ELECTRICAL PERMIT APPLICA�'ION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.evereltwa.org <br />(70 �iv_w�l,�P.� � �u� <br />PROJECT ADDRESS <br />�y�y� �PiVQ�'I7 �1�tin.�i; <br />Owner � Mail Address <br />� y_.e �v P,r z �" <br />Tenant <br />Electrical Contractor <br />S I R-UCC�( p��1 ZOL <br />Slate License Number (required) <br />���c�e Sr�w� e <br />Proposed Use of Bui ding <br />Mail Address <br />Mail Address <br />Square Footage (If residenlial new cons�ruction, remodel or addilion) <br />�� <br />Number of devices (If low voltage) <br />Ci�y <br />City <br />City <br />StatelZip <br />lni�r 9�203 <br />SlatelZip <br />� I�1�1`f 82q1 <br />Slale/Zip <br />0505�(0 <br />Phone <br />Phone <br />Phone <br />Cily of Everett Business License Number (required) <br />Conlract Price of Work <br />`%ush� D�kt � �t�-5P,3-�(GS(v <br />Conlact Person/Cont cl Number/Email <br />��s+,�,.� wk� eg���.��« <br />Descripticn of Work to Be Done .� �Si�.�� Y�AW 1 w"�'� G� ��5 �,) ��" �'` ��"� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerfi(y (fiaf 1 have read and examined this application and know the same lo be true and <br />correc(. All provisions ollaws and ordinances goveming this type ol worfr will be compleled <br />whefher specrfied he2in ornot. The granting of a permit dor s not presume (o give au(hority to <br />violafe orcancel the provisions oI any otherstale orlocalla�v regulating construcfion or(he <br />peAormance of consfruction. That I am autlionzed by the owner of this prope�iy to perform fhe <br />worfc (orwliich application is made and ! comply witli the Stafe Contractors Law 98.27 RCW and <br />REVISED 0&V6RD14 <br />FEE � <br />r � U✓ <br />"J <br />PERMIT# <br />E ��(Q-i�1 <br />