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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE7T, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetiwa.org <br />�O� S��Je ��-- lM �i (( l,t�z.� �� S <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />SSU 1 �-1 <br />Idail ntltlress <br />A1ail Atltlress <br />Eleclncal Contractor Mail Address <br />P�o �Et��- �b� � <br />State License Number <br />��'IWI��t G� <br />Praposed Use of Bwlding <br />Square Footage (If residenlial new construct�on, remotlel or adddion) <br />I� <br />Number of devices (If low voltage) <br />Descriplion of Work to Be �one <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />Cdy <br />Cdy <br />�1D �� �02-`f <br />Slate/Zi0 Phone <br />yas-�s-y� <br />Slale/Lp Phone <br />Slale�Z�p <br />Phone <br />lT �� _ <br />Conlracl Price of Work �, <br />�_ _ , , _ . , - �. 2-53-3> <br />1 hereby certdy Ihar 1 have �ead and examined fhis applicafion nnd know fhe sarne to Ge frue anA <br />rorrecL All provisions ollaws and oidinances goveming fhrs type ol woik wi116e complefed <br />whefher specified hereii� or noG 7he granfing ol a permit does nof presume 10 give aufhonty 10 <br />vinlale orcancel the provisions n/any other sfafe orlocal law �egulafing constn�clion or fhe <br />peAomiance ol conslroclion. Thaf 1 am au(ho�ized by Ihe ownei o/ fhis piopeity fo pe�fonn Ihe <br />nork lor which applicahon is made and 1 comply wilh fhe Stafe Contiacfors Law 18.27 RCW and <br />296 200 WAC. <br />��Q�.1/o� � ��/I,c/l��% �18��� <br />REVi5EDY10/17 <br />Person (Plan Review� <br />FEE <br />I �0 � — <br />PERMiT!! <br />E �30�� (��� <br />