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ELECTRICAL PERMIT APPLICATIQN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />��Z s� �l��r.�7� r�%� /��a�, 5����- � <br />PROJECT ADDRESS / <br />Owner <br />,�� vfiti Cvl/ <br />Tenant <br />�I.� ��s C <br />Electrical Conlractor <br />Mail Address <br />, <br />Mail Address <br />ClC II�'G�,z <br />Mail Address <br />5� <br />�J <br />City <br />�t/ L✓L� <br />OJ� <br />��0.�� e�( � �q Da <br />Slale License Number <br />���)I /n <br />Proposed Use Building <br />� Z �C� <br />Square Foofage (If residential new construction, remodel or addilion) <br />Numbe of devices (I( low voltage) <br />Description of Work to Be Done: �v��l.. <br />Svb PGi <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Z� <br />Cily <br />w� <br />State/Zip <br />State/Zip <br />V�O 9; <br />StatelZip <br />C l �/O ,� /E� Z <br />zo, �'- <br />Conlract Price of Work <br />Phone <br />Phone <br />yzs 7�7 <br />333� <br />Phone <br />��u � ���.2 _ <br />Contact Person (Plan Review) <br />, y� ticw L� <br />1 here6y cerlilylhat 1 have read and examined Ihis application and know the same fo be Irue and <br />cormcf. All provisions o( laws and ordinances goveming fhis (ype o! work will be compleled <br />whetherspecilied herein ornof. ihe gran(ing ol a permit does nof presume fo give authonty fo <br />violatc or cancel fhe provisions ol any other sla(e orlocal la�v regulaling consfniction or Uie <br />per(ormance o(consliuclion. Thaf ! am authonzed by the cwner olfhis property fo peAorm lhe <br />work for which application is made and I compty ,vi(h thP Sla(e Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />/� z�� 7��� <br />aeviseo arzan <br />� <br />FEE <br />'�fCO-C� <br />� <br />PERMITtI <br />E r �faa - f(�� <br />� I�01'00�1 <br />