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ELECTRICAL P�RMIT APPLICATIOIV <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 />-77 Z5 <br />,�'U rc; ('Ce.'1 ,�,�v �"cJ <br />PROJECT ADDRESS <br />Ovmer <br />f'. <br />Mail Address <br />PAatl Address <br />Electrical CONrector Mail Address <br />���I�Li— r C ��b �� <br />Slale License Number (required) <br />Proposed Use af Building <br />Square Footage (If residential new consiruclion, remodel or addition) <br />Number of devices Qf low vollage) <br />Descriptian oF Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />City <br />City <br />SlalelZip <br />SfalelZip <br />�'irc r�A�� (�i <br />s�a�e�zi <br />d �Z� � � <br />Phone <br />Phone <br />��� � <br />�Go ���PF���I1, <br />C�of Everetl Business License Number (required) <br />, .2� a �c� co <br />Contracl Price of Work <br />��C j-i,l� [ � � � p .�1 � - � � � Z, <br />Conlacl Person/Con�acl NumbedEmail <br />I hereby certi/y fhat I'�ave read and examined this applicafion and kno�v fl�e same to be (rue and <br />coneci All Provisions ollaws and ordinances goveming this type ol work will be comple(ed <br />�vhelherspecilied herein ornoL The 9ranting ol a permif does nof presume to give aufhonty to <br />viola(e or cancel fhe provisions ol any ofher sfate orlocallae� regula(ing construcfion or fhe <br />peAormance o/ consfruclion. Tliat I am aulhonzed by !he owner ol this property lo perfomi the <br />wo�(or which application is made and 1 compty with (he Sfate ConVactors Law 18.27 RCW and <br />296.20Q WAC. <br />- � ���s �i y <br />REVISED 09�0640I i <br />FEE <br />550� <br />PERMIT+9 <br />E l�-I I 1- l� <br />