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�' ELECTRICAL PERMIT AP�LIGATION <br />'i GITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />� 425-?.57-8810 - FAX 425-257-8857 —www.everettwa.org <br />i �D�S` �S� L��'-�%l ��/��-L w�/ �, <br />PROJECT ADDRESS �,zS <br />Tenant <br />tda�l Address <br />���L I��L <br />L1aJ Address <br />Stale licens'e Number (required) <br />Proposed Use ol Oui!ding <br />i Square Footage (I( residenlial new construction, remodel or addition! <br />Number of devices (II low vollage) <br />I Description of Work �o Be Done�. � <br />� ��1�. ���--,�- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />C�ty <br />� �Y <br />SlalelLp <br />Stale'Z��p <br />Pl�ene <br />4Z 5 <br />_/rl <br />r honC <br />� � ��� <br />City o( Evarett Business License Num6er (required) <br />� Iq.�� <br />Conlract Pnce of Work <br />Contacl Person'Contact NumbedEmail <br />FEE ; �� <br />� G �s �j--J <br />1 hereby certily tha( I have roaJ and examined fhis applicifion and hnow the sare lo be tnie and __ _ _ <br />r.onecL All piovisions ollaws and ordinancr.s goveming fhis type o/ work �vill be completeA <br />wheU�er specilied hemin ornof. (hc qranfing o( a pennd does not pr..�surne to 9ive aulhonty to PERMITN <br />vicla(e or cancel fhe provisions o/ any olher sfate or local !aw regulahng constn�ction or fhe ��� O� � I�^ <br />performance o/ consfrtiction. Thaf I am authonzed by the on�ner ollhis prcperty to peAomr Ihe � L <br />r:ork lor �vhich application is made and 1 comply with fhe Sfafe Contnctors Law 1827 RCW and <br />zss,zao wnc. � „ <br />F::'..S! C G'_4.:0'� <br />