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ELECTRICAL PERMI�' APFLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVER[TT, WA 98201 6 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org �' <br />�� � <br />PROJECTADDRESS <br />-7.3—/�( <br />lyob-�34 <br />Owner <br />�9ail Address <br />Mail Address City <br />_ �2 l Nc� Can�D� . / <br />Mail Address <br />�, � ,��-��,�'� 1 K <br />St`a e LicBrise Number � <br />in <br />��-� �l `� � U � � /l , _ <br />Proposed Useiof Building <br />1 �� <br />Squ� Footage (If residenlial new conslruction, remodel or addilion) <br />.11 <br />Number of devices (Il low voltage) <br />of Work to Ne Done: <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />City <br />a�aceiup <br />�f�orD `�' <br />Stale/Zip Phonc <br />36� <br />SlatelZip <br />`— r � <br />Conlr� of� <br />Conlact Person (Plan Review) <br />1 here6y cerfdy fhat ! have read and examined fhis applicalion and know the same (o be fiue and <br />correcf. All provisions o/laws and ordinances goveming fhis type o/work wi116e comple(ed <br />whefher specificd hc�ein ornot The granfing o(a pennit does not presume (o give aolhonty fo <br />violafe or r,ancel fhe provisions ol any olher slate orloca!!aw regulafing consfrucfion orthe <br />pedormance o(construclion. That 1 am aufhonzed by fhe owner ollhis prt�periy fo perlorrn Ihe <br />worfc lor which applicafion is made and 1 comply wi(h fhe Sfale Contractois La�v 18.27 RCW �nd <br />296.200 WAC. <br />Phonc <br />FEE <br />�� �-C[) <br />PERt1IT,9 <br />E ��I-��(�- f� <br />