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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ClS/0 yZ0 !J <br />425-257-8810 - FAX 425-257-8857 — www everettwa.gov _ � y <br />io--a7 <br />Z�� s.�. ��F� ,��� ��y <br />PROJECT ADDRESS <br />Owner <br />��EHa�sE <br />Tenant <br />tAail Address <br />1.1ai1 Atltlress <br />C�ty <br />C�ry <br />S�ate/Zip <br />SIaIOIZip <br />PhonC <br />Phone <br />If��o�✓�1. Sr�i✓ co�4• IZSS Wt511�i1(( �• �✓ S�A�fi�� wq. qg109 �id�Z�1-a>d0 <br />Etectrical CoNractor tda�i Atlaress C�ry Siaie2�p Pnone <br />NA�osco3►M3 DD 3d0� <br />State License Number (reqwred) Gry ol Everetl Business License Number (reqwretl) <br />_ �.1��•�0 <br />Proposed Use of Butltling Conlract Pnce of Work <br />Square Foota9e (It residential new cons�ruchon, remodel or atlddion) <br />Number o( devices pf low voltage) <br />S-fEV� ?�►�B�,t c►�l <br />Contact Person�Contact NumbeuEma�l <br />2`n�- 2aZ-o 700 <br />$�Q% Z y/1 !}�e�►q�51'/ICa��l. �a�►1 <br />Descnpt�on ol Work to Be Done ��f7� Z a�� V"�'" s��l <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />1 hereby certdy Ihaf 1 have mad and examined tlus app6calion and know Ihe same fo be frue and <br />conecf All provisions ol laws and ordmances govemmg fhis type ol �vork wdl be complefed <br />n-hether spec�(ed hermn or not. Thc granting o� a permd does not presume to grvc aufhonty to <br />vrolafe or cancel fhe prowsrons I any olher sfafe or local law regula6ng consfn�cfion or the <br />peAo�mance ol consfruction haf I am authonzed by fhe mvner ol fhis propeRy fo peAorm !he <br />work for wh�ch applrcahof rs ade and 1 comply wdh the Sfate Confra[lors Law 78 27 RCW and <br />296 200 WAC A � <br />0-Z � (S <br />FEV�SED 089�0' J <br />FEE <br />�D °� <br />PERM[T!f <br />E c�(D -��� <br />