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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 — wvuw.everettwa.org <br />�.3a �7 �i/� �7" <br />PROJECT ADDRESS <br />FGE�t'E1T <br />Owner <br />Tenant <br />Con�rac�or <br />�,P✓T_ j/ J/D <br />Mail Address <br />Mail Address <br />Mail Address <br />State License Number (required) <br />���Ti �A/l/� y <br />Proposed Use of Building <br />���� � <br />Square Footag (If r idenlial new construction, remodel or addition) <br />City <br />City <br />City <br />StalelZip <br />Slate/Zip <br />q_ab-�y <br />�,�o����y <br />�2 � <br />�iA Z r� j <br />Phone <br />Phone <br />Nnone <br />Cily of Everett Business License Number (required) <br />Contract Price of Work <br />Contact PersonlContact Numbed[mail <br />Number o( devices (I( low vollage) <br />Description of Work ta �e Done: L � > � <br />S�/�//lC� %a �/�� ,0�//�'%l G � �ir/i-T� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceRily fhat I have read and examined this application and know the same to be Irue and <br />correct. All provisions ollaws and ordinances goveming this fype oI work will be complefed <br />whelherspecified herein ornoL T6e graafing oI a pertnit does not presume fo give aufhonly to <br />violate or cancel fhe provisions o/ any otl� er state or local law regulaling construction or fhe <br />pedormance ol consfrucfion. Thaf 1 am a.ufhonzed by !he owner o/ lhis properfy to pedonn the <br />work .'or \w�h�i�c_h application is made and 1 r.ompty with fhe Slate Contractors Law 18.27 RCW and <br />296.200 K%. „ <br />'' � �'. <br />REVISEOOBNfiQOia <br />FEE <br />�� �b <br />PERMIT# <br />E f�a �l' /S� <br />