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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 3 �'3 �-� <br /> �i�a a�5 <br /> ���� �/� � <br /> PROJECT ADDRESS <br /> �� �� P � �Kl�'`Qi� �� �'"�G <br /> Owner Mail Address Gty Slale/Zip Phone <br /> TBnanl Mailnddress Cdy Slafc/Zip Phonc <br /> i ��� ��1,� �,c� S{��'l,� ��, q�?SSr � q-�- — <br /> ElectricalConlractor h9ailAddress City SlatelZip Phone <br /> State License Number �� Con iacl Price of W—<��ork <br /> Proposcd Use of Duilding Contacl Person (Plan Review) <br /> Squaie Poolage Qf residential new conslruclion, remodel or addilion) <br /> Number of devices (If low vollage) <br /> IJescriplion of Work lo Be Done: ,`�(-�� ��""�Ll��' • �V"' ' ^'� �`� �� <br /> � <br /> FFE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 75 Q� <br /> I hereby ccilrfy Iha�1 have rrad and examined Ihis applicafion and know Ihe snme(o Ge fn�e and <br /> r.orrecf. �II provisions ollaws and ordinances govr,rning flris fype olwnrk�vill be compleled <br /> vihefl�e�spec�(ed heroin ornoL Tfre 9�an(ing o/a pemiit docs nol piesmne(o give authonty fo P[RMiT71 <br /> viofale or cance!fhr, provisions ol mry olher sfale or local law regulaling consfrticfion or fhe � � � O� ` DO� <br /> pcifonnanr.e o/r.ons(n�clron. Thaf I am au(horized by Ihc owncro(Ihis propertylo perlorm fhe <br /> wnrk(or whir,h app6catron is modc and 1 compry wdh thc S7afc Conlrar,(ors La�v 1Q.27 RCW and ___ <br /> 296 20D WAC. <br /> ���"'i --- -_ .------- <br /> � Signalurc — -- -- _—�- p, , <br /> et wsi o u.•an <br />