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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 425-257-8657 -www.everettwa.org <br /> � q �S �O 2 ES i vil� /✓/ln�f <br /> PROJECTADDRESS <br /> ���„' �,�.� �:�+r'n n�/� 9 S y8 S� sr ��S d GuR 98 �36 <br /> Owner MailAdtlress Ciy Slate2ip/106� Zoo• Z�J�one <br /> C <br /> Tenan� Maii Address Crty Slate2ip Phone <br /> �o i17YGd ��dc�ylcz SN� �Q_l��, 5 3 5 /.c Y�ootwu�t GtAt 9yU7 2 <br /> ElednCal ConiraCtof Mail Address City SlalelZip�yZS)y8 3 • 0 3 j3 e <br /> CoTr/}Er47yaH 053ra�0 <br /> Stale License Number(required) City of Everetl Business License Number(required) <br /> �IE �m�.o �E '�2Yoo. tO <br /> Proposed Use of Building Conirad Price o(Work <br /> To Tif�rr,c �Zo6�34r -/y73 <br /> Square Footage(It residential new construction, remodel ar addition) Contact PersonlContact Num erlEmail <br /> Number of devices(I(low voltage) <br /> Descnption of Work to Be Done: /GE/�CRc d �xLST�..� ZUJ /9i..n !'�� WA7t <br /> /�.E[w �n�u!` �Olrccr �wtific�t LUatn.f �tT �'�*"�+ ` <br /> /�rtU� - <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��5 �O <br /> i <br /> 1 hereby ceriify that 1 have read and examined thrs applicafion and know fhe same fo be true and <br /> cortecf. All provisions ollaws and ordinances goveming fhis type o/work will be compfeted <br /> wl�efher specified herein or not. The granting of a permif does not presume lo give aufhonty to PERMIT# <br /> violafe or cancel lhe provisions of any ofher s(ate or local law regulafing consfrucfron or fhe � I � O� I � �oO <br /> perlom�ance ol consfruction. That 1 am aufhonzed by fhe owner oI(his property to peAorm the "� <br /> work for whicb application is made ond 1 comply wifh the Sfafe Contracfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ,%� ,.- 5'/30�i s <br /> Signat e Dale <br /> REVi5E0080640�< <br />