Laserfiche WebLink
ELECTRICAL PERMIT APPLICATIOi� <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 />.` � 70� �U�2-�.��v GcJi`� Y <br />PROJECT ADDRESS <br />Owner <br />QI� 5 <br />Tenant <br />Mail Address <br />Mail Address <br />Si�S <br />ElectricalConlractor MailAddress <br />PR-i n� �s L �d83 cz�- <br />Stale License Number (required) <br />'C1� vv�w��R fl�i <br />Proposed Use ot Building <br />'75ac7 <br />Square Foolage (I( residential new construclion, remodel or addition) <br />2S • <br />Number of devices (I( low wltage) <br />Description of Wark to Be Done: 5 g-�7Yz-i�f <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />City <br />City <br />Ciry <br />Slatel2ip <br />StalelZip <br />S�atelZip <br />Phone <br />Pho�e <br />Y�6g2 s <br />Phone <br />I �� ' <br />City of Ever t Busines Li nse Number (required) <br />� Soo <br />Con�racl Frice ot Work <br />��n ar �i9r''�17 <br />Contacl Person/Contact NumberiEmail <br />(s�3) 312-o9a/ <br />1 hereby certily fliaf 1 have read and examined Ihis applrcafion and know the same to be frue and <br />cormct. All provisions o/ laws and ordinances goveming (his fype of wo�ic will6e complefed <br />whefherspecified herein ornol. The granfing o(a peimit does not presume fo give aufhonty io <br />violafe or cancel the provisions ol any other slale or local law regulating consWcfion or Ihe <br />perlormance ol consfruclion. Thaf 1 am aufhonzed by the ownerol this properfy fo peAorm flre <br />worlr /or which application is made ard I comply wi(h (he State Contractors Law 18.27 RCW and <br />REVISED Od.06/I019 <br />FEE. <br />�5 ° <br />PERMITN <br />E � �fio - o�a <br />