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ELECTRICAL PERi1liIT APPf�ICATION <br />I�O� 5 E <br />PROJECTADDRESS <br />L� <br />Ovmer <br />Tenant <br />CITY OF EVERE�T PEkMIT SEFVIC�� <br />3200 CEDAR STREET, EVER[TT, WA 9820'1 <br />425-257-8810 - FAX425-257-b85i —www.everettwa.org <br />� re. �f N�I I �— <br />Zq-� I O�r�,h f��c <br />Mail Address <br />Mail Address <br />5 M E ;�� a.� �f___}�� <br />EleelricalContraclor Mailnddmss <br />�M�iNs� r��� R <br />Slate License Number <br />r�l�; �I <br />Proposed Use of Bwidmg <br />Square Footage Q( residential new construclion, remodel or addition) <br />2 <br />Number of devices (II low vollaye) <br />� f 1�1 <br />Gty <br />Gty <br />cay <br />C /{ ` <br />State�Zip <br />StatelZip <br />{/�F 1 <br />StatMZip <br />� �—o3--i3 <br />E�3 /z-�/Z <br />Phone <br />Phonc <br />�i:a. � c <br />�, - � <br />�� �� �1 l V `-� -- <br />Contract Price of Work <br />Contael Person (Plan Revie�:i) <br />(Jesr.ription of Work lo Be �one� _l�� _� 1 ���� �' ��'I J—+ � ��� /'���- <br />�_ /_i _�...�li � n�o�.l (,ff�n,r I D��_�.__.,�r��7. 2 i'/l�..l�-. Ir !l�'S <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily thal 1 have iend and exarnined (his applica(ion and kncw lhe same fo be frue and <br />conecL All p�ovisions o(laws and ordinances governin9 Ihis (ype ol work will be carnpleted <br />�vhefher specdied herem ornoL Thc grantmg ol a penm( does nof prr.surne fo yr�e aulhoiity (o <br />violale oi cancr.l fhe p�ovision any olher sfa(e or local law regvlating consfn�ction or the <br />per(onnance ol consfn�y•!i i Th� !! am aulhonzed by the owner ol Ihis proper7y fo perfmm fhe <br />work lor v�hich appl�[�ion is adc and I cornply vnfh fhc Sl�le ConVactors Law 18.27 RCW and <br />296 200 IyQC. / <br />— -----� ����— <br />o,� <br />,������„��o,., <br />F[E -- -- <br />I��-�f-� <br />PER.MCTJI <br />E 13�Z�o�v <br />