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ELECTRICAL PERMIT APPLiCATiON <br />CITY OF EVERETT PERMIT SEi�VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 Q- FAX 425-257-8857 - www.everettwa.org s� 1--� 5 <br />�wlSos �I <br />� 1 I ��l-�� ,��� 5�- i�-�..e. �fw�- <br />PROJECT ADDRESS � Z�� <br />�"l� � Ps-0� �-�I o ��� ,�f ����1" ��- � ��'3 �a (�w <br />Own r Mail Address City State/Zip Phore <br />Tenant <br />Mail Address <br />Ci�y <br />Slale2ip <br />Phone <br />Z°� <br />NEw <� FE �����c S%2g I`il'�`�5r5E ��,��2.=� w� �/BZ�� 755-36 <br />EledricalContracror MailAddress City Slale/Zip Phone <br />l.��w L,�� $�12J H <br />Stale License Number (required) <br />Proposed Use of Building <br />� e�� <br />Square Foolage (It residential new construction, remodel or addition) <br />Number of devices (I( low vollage) <br />(��ll� `f� <br />City of Everetl Business License Number (required) <br />Coniract Price of Work <br />i�rnNc�r„y 7o,e� Z06 `755�606 <br />Conlact Person/Contact NumbedEmail <br />Description of Work to Be Done: ��e��C� t. ? c�f�� � �<�-�e � L__Y�� -� ��^-��w� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heieby cerli/y fhat 1 have read and examined this applicafion and know the same lo be froe and <br />cormct. All p�ovisions oflaws and ordinances goveming this fype o/ H�ork will be comple�ei <br />wbefherspecified herein ornoL The gran(ing of a pemiit does nof presume (o give authonty (o <br />violate or cancel Nie provisions of ary ofher stafe or local law regula(ing consWclion or fhe <br />performance ol conslruction. Thaf ! am authonzed by the ownerol this property lo perfo�n the <br />work /or which application is made and 1 comply wilh lhe Slule Conlractors Law 1827 RCW and <br />296.200 WAC. <br />� 5� f S <br />Sig re Dale <br />REVISE�OBN6ROI•I <br />F[E <br />l��i <br />PERMITN <br />E � ��05- 00( <br />� <br />