Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMI'T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 — www.everettwa.org <br />2/� S'uJ �d�2�il" %%/tu �� <br />PROJECT ADDRESS <br />Owner <br />Mail Address <br />Cily <br />State2ip <br />��a-�� <br />� � [tDl_oo3 <br />Phone <br />�oor��-v � 7/0 L��- ST S�; ;, r� G�%� <br />Tenanl Mail �ddress Cily SlatelZip Phone <br />/(/�`7urnzx GV/2.✓� ��u//ct5 r,��/� ���� .'Ti SCfi�'/OG� /%vJ�.vn�P��`�zz�� �i� 1�, <br />Elecirical CoMractor Mail Address Ciry SiatelZip Phone <br />y2s- Q7� ��71 <br />�ET7,vGY/./5 �iSL� <br />Stale License Number <br />Proposed Use o( Buildin� <br />Square Foolage (I( residential new construclion, remodel or addition) <br />8G <br />Number of devices (II low vollage) <br />Descriplion of Work tu Be Donc: /NS� C'� �e <br />CITY OF EVERE7T LOCAL SALES TAX CODL i5 9105 <br />���6D � <br />Conlract Price of Work <br />�9.✓ /A�'�C y <br />Contact Person (Plan RevievQ <br />f�0/cc Ti I%ri"T/y' CAaL� <br />! hcreby ccitiJy Ihal 1 have read and examincd Ihis appiication and know Iho sarne tn be frue and <br />r.onecL All piovisions of laws and ordinances yoveming Ihis type of work will be cornpleted <br />whefher spccified herein ornol. The gnn(ing oI a Fennif does not pmsume ro give aulhonty (c <br />violafe or canccl lhe p�ovisions o/any other sfate orlocnl law regulaling constniction orlhe <br />perforrnance of cunsln�clion. Thaf 1 am auUtonzed by fhe ovmer o/this �ron��iy io n�do�,� rne <br />work !or which a� plicalion is made and 1 co nply with fhe Sfate Confr�cbis Law 18.27 HCW and <br />anR Onn IA/AC <br />REVISFUYliJU <br />FEE <br />58. o0 <br />P[RMITN <br />E I�o!- DD 3 <br />