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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 />7��y CLCrGCY�Pn i�s�� Lh��— <br />PROJECT ADDRESS <br />Electrical Contractor <br />Mail Address <br />Mail Address <br />Mail Address <br />FAfiUI�'�.:�i ��i� l'�Y <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (I( residential new construclion, remodel or addition) <br />�/ <br />Number o( devices (I( low voltage) <br />Description of Work lo Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />V <br />City <br />City <br />City <br />Slale/Zip <br />Phone <br />Slale/Zip Phone <br />��53-bUy- L/34/ <br />Stale/Zip <br />Phane <br />6,S! y t � <br />Citv of Everell Business License Number (required) <br />•jpcLoll �'CTI� <br />Contract Price of Work <br />�� irnO �lJ�%v– v7S��Gl't���j� <br />Conlacl Person/Contact NumbedEmail <br />1 hereby certify that I have read and examined liiis applicafion and know fhe same to be (rue and <br />correct. All provisions of laws and ordinances goveming this type o! work will be comp/eted <br />whethe�speci(ed herein ornof. The granting oI a permil does not presume fo give aufhonfy fo <br />violafe or cancel lhe provisions ol any olher state orfocallaw regulafing consfruction or �he <br />performance o/construclion. That I am aufliorized by the owner ollhis properfy (o peAorm fhe <br />work lor which applicalion is made and 1 compty with the State Confracfors Law 18.27 RC W and <br />29G.200 WAC <br />REVISED 08rt1N1of o <br />FEE <br />5d �° <br />PERMITN <br />E ���0--d6� <br />