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ELECTRICAL PERMIT AP'PLICATION <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 /> ��� �d'c5? U�CcJ �V�U-2 <br /> PROJECT ADDRESS <br /> �b�.� Lyw� G�✓►� <br /> Owner Mail Address City SlalelZip Phane <br /> Tenant MailAddress City State/Zip ��� Pho� <br /> 8-8 38 <br /> G� su;s�. �/�, � ✓�, �k /� c„�t ���� <br /> Electrical CoMractor Ma�l Address Clty StatelZ�p Phone <br /> ��n Ss� Qa� 1n �5�37 ( <br /> Sla e License Number(required) City of Everetl Business License Number(required) <br /> Proposed Use o(8uilding Contract Price of Work <br /> Square Footage Q(residential new construction, remodel or addition) Contact Person/Contact NumbedEmail <br /> Number ol devices(If low voltage) <br /> Description of Work to Be Done: � tA�.�+� �U�'�-''� � ``` U���+Q- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 ��J O� <br /> 1 hereby certily that I have read and examined fhis application and know fhe same to be true and <br /> conect. All provisions ollaws and oidinances goveming fhis(ype o/work will be completed <br /> whetherspeci(ed herein ornoL The grunfing ol a permd does not presume(o give aufbonty to pERMIT# <br /> violafe or cancel the piovisions ol any ofher sfate or local law regulating conshuction or the � �, r I I � O�a <br /> per(ormance o/const cfion. Thaf 1 am aufhonzed by the ownerol this propeRy(o peAonn the �I ( <br /> work for which applic ion is ade and I comply with the Sfate Contracfors Law 18.27 RCW and <br /> 296 0 WA <br /> /�/o/�f <br /> � gnature Dale <br /> REVISE00606401� <br />