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E�.ECTRICAL PERMIT APPLICATION <br />CITY OF EVEkETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-6810 - FAX 425-257-8857 - www.everettwa.org <br />.� l S S� �li -P � C 7�� M4 /! w^ y <br />PROJECT ADDRESS <br />Owner <br />h7ail Address <br />City <br />StatelZip <br />�l-a�`��/ <br />Phone <br />S f/� ��vc� S S/.S -,.f'F �-l�-r.r7`t �/ k., ,, L-"vt., j-f- c,�q � SZ ri � <br />Tenant Mail Address City Slale/Zip Phcne <br />>ti <br />Electrical Con�ractor MailAddress <br />�O i' fi- s �� S� �G /,, <br />Slate License Number (required) <br />� � -�PY s��% <br />Praposed Use of Building <br />Square Footage pf residential new conslruction, remodel or addilion) <br />Number of devices (I( lov+ voltage) <br />City <br />s� �,.,� 9�zs o <br />State/Zip <br />os �S3 2-. <br />Phone <br />City of Evered Business License Number (required) <br />a <br />fr' �- ,. -� � b0 °� <br />Contracl Price o( Work <br />%�r��e U'r�,�res y%S,�%SO�/� <br />Contacl Person/Contact NumbedEmail <br />Pa. hr a s 2ZQ r�7,j.v . C ��'"7 <br />DescriptionofWorkloBeDone: /cY��G�t P��St,^�5 S-9��5 w,'f"�i tir �- L.G' /, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />1 hereby certily fhat I have read and examined lhis application and know the same to Ge frue and <br />cor2ct. All provisions ollaws and ordinances goveming this lype ol work will be completed <br />whether speciTed herein or noL The granfing o/ a pemiif does not presume to give aufhonty to <br />violafe or cancel (he pravisions ol any ofher sfate or local lav✓ regulafing construcfion or fhe <br />perlortnance o/ construction. That 1 am aufhonzed by fhe owner ol fhis propeRy to peAorm fhe <br />�vork lonvhich application is made and I comply with !he Sta(e Contractors Law 18.27 RCW and <br />296.200 WyG. <br />-/�-��/% <br />FEVISEDOflR1Y20iJ <br />FEE <br />�D °� <br />PERMIT# <br />E l�t!- ��� <br />