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t� ECTRICAL PERMIT APPLICATION <br />CITY OF EyERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� 7�-S �, ���, ✓ . <br />PROJECT ADDRESS <br />Tenant <br />Eleclncal Conlraclor <br />�da�l Address <br />htail Adaress <br />AdGress <br />� L �.i �S )1,�75 R� <br />S ate License Number (required) <br />I�Pi�'o•`' <br />Proposed Use of 8uilding <br />.� �/oo <br />Square Footage (If residenual new conslruction, remodel or addiUon) <br />-L� <br />Number o( devices Qf low vollagc) <br />Descriplion ot Work to �e Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />C�ry <br />Cay <br />Ciiy <br />Sta!elZip <br />StatelZip <br />SlalelZip <br />Phonc <br />Phone <br />Phone <br />V� J��� <br />Ciry of Everett Business License Number (required) <br />`�/�00l�� <br />Contract Price of Work <br />�,����1�����Z �as�-��-6ys�S <br />Contacl Person/Co In act Number/Email <br />I hereby certily Ihaf 1 have read and examined fivs aPPhca(ion and know (he same to be frue and <br />correcl. All provisions o/laws and ordinances governmg fhis type ol wo�k wdl be comple(ed <br />�vhefher specilied heiain or not. The granfing oI a perrmt does nof presume to give aufhonty fo <br />violafe or cancel fhe p�nvisions oI any ofhe� state or local law re9ulafing construcfion or the <br />peAormance o/ conslrucfion. That 1 am aufhorized Gy the owner o/ fhis piopeRy to peAorm the <br />work lor which applicafion is made a I comply wilh the Sfafe Contractors Law 18.27 RCW and <br />296.200 WAC. <br />�i✓ �,., l /�7iS �� �l <br />FEV�SEOOBOfi/ION <br />FEE <br />�OO� <br />i <br />PERMIT# <br />EI�}II-2((� <br />