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ELECTRICAL PERMIT APPLICATION <br />CITY QF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 – www.everetiwa.gov <br />Ln�� J� �l�e✓G-�/-�v1u,L� n)Ccy GUPVi-/f �t%{� <br />PROJECT ADDRESS <br />�G <br />Owner <br />Mail Addmss <br />Mail Address <br />EleIXriCalContfactor MailAddress <br />�wrc�nSL�3�k1 <br />State License Number (required) <br />(r�tiliu �-f'�!'� ( <br />roposed Use of Building <br />C�ry <br />o `eG <br />City <br />� <br />City <br />Square Footage (If residential new construdion, remodel or addition) <br />Number of devices (If low valtage) <br />Desaiplion of Work ro Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CUOE IS 3105 <br />State2ip <br />SlalelZip <br />�� <br />Phone <br />Phone <br />2_ S3 S�Z- . <br />Phone <br />� b �-k ��1 I <br />C�iP f Everett Business License Number (required) <br />�/2oC� <br />Conhaa Price of Work <br />�.l�d.�—�1z�1+�25�•'70S' �6�� Z <br />Contact PersonlContact Number/Email <br />I hereby ceRily that 1 have read and examined this applicafion and know the same (o be true and <br />correcL All provisions ollaws and ordinances goveming Ihis type oI work will be comp/efed <br />whe(her specifieU heiein or nol. 7he grantiny ol a permit does nol p�esumo to grve aulhonty to <br />violate or cancel (he provisions o/ any otber state orlocal law regulafing consfruction or fhe <br />pedormance ol consfrucfion. That 1 am aathonzed by Ihe owner o( (his property to pe�lorm the <br />n•ork Ior which appficafion is made and �mply wi(h fhe State Contracfors Law 1827 RCW and <br />- JS � <br />REVISEU08�➢6�101( <br />� <br />FEE <br />�-� � , � <br />PERMIT# <br />E 15D g'�"1� <br />