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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 —www.everettwa.org <br /> �g, so�- -�`�3 <br /> � -a3 -� s <br /> '-t Iz� ��,.y-�- �1e. <br /> PROJECT ADDRESS '�i3 �D 3�D <br /> r <br /> �^_����,r��_,., �19t>S � 1, ,..�...-c. -A�t L�erY, WA 1`��03 <br /> OwnC� � hladAddres5 Gty StatclZ�p Phone <br /> I <br /> Tenanl hlailAdtlress City Stale.Zp Phone <br /> ���,�,.� , � 45�t n� 3oo�,J ��✓° Lc7' Sly6o`� 8�� `t�7 ��6T <br /> EledricalContractor Lta�lAddress C�ry State,Z�p Phone <br /> 1 .�-, � � � �� ��J�1 S��lD <br /> Sta� Li ensc'Jurrber(equire� City o(Everett Business License Number(required) <br /> Proposed Use of Building Coniract Pnce of Work <br /> Square Footage(If residenlial new conslruction, remodel or addition) Confacl PersoniContatl Num�edEmail <br /> Number of devices (II low vollage) <br /> Desaiption of Work lo Oe Donc: ��-��^ `'`��"` '-"r- '"e � � <br /> �-- <br /> F[E <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� D O <br /> I hen;by cerfily that 1 have rcad and ex��mined this applicatron anA kno�v thc samc(o bc tnie and ___ <br /> cormct. All provisions ollaws and ordinances goveming this type ol worfc n•ifl Ge complefed <br /> whefhcr specified hemin or noL The granting o(a pe�mit does nof prcsmne to give aufhorty(o pERh1IT� <br /> violate orcancel fhe provisions oI any ofher stafe or focal la�v regu/atin�consWction or Ihe E g �SD ?fo�(3 <br /> perfom:ance ol consfruction Thaf 1 am aufl�o�ized by fhe o�vner o/this pr�perty to pe�fomi fhe <br /> �vork Ior which appl catron s made and I compty with fhe State Con(ractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �� -- <br /> �c�j Z3 Z�l�-� <br /> Sig alure -- Date <br /> -��,�rroisc:.;r, —.— — _--- - --- <br /> �__—.. ___ _ �_,__' _ <br />