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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—wvrw.everettwa.org <br /> c� � a1 � � ��n S-4-r'-e e.�- <br /> PROJECT ADDRESS <br /> Naack II�+tiers Hames 39228'��'�� � M��ys�; I �e (.t,Y�98Z76 <br /> Owner Mail Addmss Ciry SlatelZip Pho�e <br /> q2S- 2`��-2yZ9 <br /> Tenant MaitAddress Ciry Slate2ip Phone <br /> EledriC2i Con[fBCtOf Mail Addmss Ciry Slate/Zip Phone <br /> State�cense Number Contract Pnce of Work <br /> S ` �_ <br /> Proposed Use of Building Contad Person (Plan Review) <br /> Square Footage(If residential new conslrudion, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done. \��� �`e C�� � q I <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 � ,.,�\ <br /> vV <br /> 1 hereby certily thal l have�ead and examined fhis applicafion and know the same to be frue and <br /> correct. All provisions o/laws and ordinances govemr��g fhis type o/work will be complefed — <br /> whether specifiod heiein ornof. The granting ol a pemiif docs not piesume to givo authonry(o PERMITIt <br /> violafe or cancel fhe p�ovisions ol any ofher state or local la�v regulaNng consfrucfion or fhe <br /> perfortnance o/constrt�ction. That I am au(horized by the owner o/fhis property fo peAortn the E ' �� �� O ! '� <br /> work lor which applicafion is made and 1 comply wifh fhe State Confracfors Law 18.27 RC W and {o <br /> 296.2 AC. <br /> 3 �- ► 2�- ► y <br /> Sig atum Dale <br /> REVISEDYl <br />