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ELECTRICAL PERMIT APPLICATION <br />� fj � <br />PROJECT ADDRESS <br />Tenant <br />Electrical ConUactor <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 />Mail <br />Mail Address <br />Mail Addrass <br />�y`'�7�-x...o 2-� ,-z,��[! <br />Slate License Number <br />' -`�\ <br />Proposed Usc of Building <br />a�$� <br />Square Footage (If residential new consWdion, remodel or addition) <br />Number of devices (If low vollago) <br />!,��� <br />City <br />� <br />Ciry <br />� <br />City <br />/Z—S—/3 <br />[_13/z-�U� <br />Statc2ip <br />S�ete2ip <br />�gr3� <br />Phone <br />Phone <br />��� �N� �7�- 7� 77co <br />StatelZip Phono <br />� �2,�00 <br />contract Prl_ce or work <br />Contact Person (Plan Review) <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 3705 <br />1 here6y certily fhal 1 have read and examined this applicalion and know the same fo be Irue and <br />correcf. All provisions o! laws and ordinancos goveming Ihis type ol work will be complefed <br />whefher specificd herein or noL Tlic granling o/ a permif does nol pmsume (o give aufhonty fo <br />violafe or cancel fhe provisions ol any ofher sf or local law regulaling construcfion or fhe <br />perlormanco ol coJ�frucfion. That 1 am aufh ed by (he ownerol fl�is propertylo peAorm Ihe <br />woAc lor w/jicb a�fpl�Caf�r/y's m�'�le a� I�om with Ihe State Conlracfors Law 18.27 RCW and <br />�2�� <br />nmseo.vfdn <br />FEE <br />� 300� <br />PERMif# <br />E I3Iz- 02g <br />