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�LECTRICAL PERMIT APP�ICATION <br />1 �-( (� �. 9 <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Eledrical Contraclor <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 />Mail Address <br />Mail Address <br />Mail Address <br />��v������a�3 �� <br />Stata Licen�e Number <br />�� � <br />(_v� ��L�� �LLn � . <br />Proposed Use of Building <br />City <br />I �t U 2. <br />; <br />City <br />� g1 �.1 U..) . <br />City <br />Squar*m Footage (If residenlial new conslruclion, remodel or addition) <br />�7 <br />Num6�r of �evices (If low vollage) <br />Descriplion of Work to Be Done: <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />�-4��3 <br />G �-3o�-d3� <br />Stale/Zip Phone <br />� �Ael��Wt2Q� �� <br />S al lelZip Phone <br />�.�,) (,Q (� - t I � � <br />� 1����ti� ��.?A q �c� I <br />SlatelZip Phone <br />Contr � Price af Work <br />if71.lJ� 11=-- - — <br />Conl�ct Po �on (Plan Review) <br />I hereby ceRi(y that 1 have read and examined this application and know the sarne to be 6ue and <br />correcf. All provisions of la�vs and ordinances goveming this type o( .vork will be cornplefed <br />whether speci�ed herein or not The grantiny o/ a pemiit does not presume fo give authonty to <br />violate orcancel the provisions o/any other state orlocal law regulafing consfn�ction or the <br />perfo�nance o/consWction. That I am authonzed by fhe o�vnerol this property to pedorm Ihe <br />u�ak (or which applir.a(ion is made and I compty with fhe Stafe Con7ractors Law i8.27 RC W and <br />296.200 WAC. <br />/V'y <br />ni:l—=�CtiO "l'v"7 <br />C <br />FEE �� <br />��� <br />J <br />PERMIT# <br />E i���4 -o ,��5 <br />