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ELECTRICAL PERMIT APPLICATIQN <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FNC 425-257-8857 — www.everettwa.org <br />� l� M 9�-c� no � r u� j�-� � <br />� <br />PROJECI'ADDRESS <br />S � �- 2�. I ln <br />t�wne� <br />Tenant <br />��. }-e� R �- ST, <br />State Lice— nse Nur�er (required) <br />Proposed Use of 6uilding <br />Mail Address <br />Mail Address <br />Ciry <br />City <br />• 2f�S(oFt„ri �Ln1�W�W < <br />Mail Address <br />�� s <br />Square Fo age (I( resideMial new construction, remodel or addiUon) <br />City <br />Stale/Zip <br />Slate/Zip <br />Phone <br />Phone <br />k �1�Z�L Uzs3�/c��3o <br />State/Zip <br />Phone <br />Ci�y of Everetl Business License Number (required) <br />� 3 S� <br />Conlract Price of Work <br />C� �( � 3�( (,� - 0�5 v <br />Conlact Person/Contacl Number.'Email <br />Number of devices (I( low vottage) <br />Description of �Vurk to [ie Done: /l.� e-�--� ��� UCc-Q, {Sfl t�� (�'^"�� <br />'� �c d�a� <br />CITY OF EVERETT LOCAL SAI.ES TAX CODE IS 3105 <br />I herei,y cedi/y fhat 1 have read and examined (his applica(ion and know the same (o be fn�e and <br />correcL All provisions ol iaws and ordinances goveming tbis type ol work will be comple(ed <br />whefherspeci(ed herein ornoL The yranfing o/a pennit does nof presume lo give aufhonly (o <br />violale or cancel the provisions ol any olher state orlocal law rngula(ing construction or the <br />peAomiance o(consfrucfion. That I am aulhonzed by fhe owner o/ (his prope�iylo pedomi the <br />work lor which applicafron is made and I compty wifh fhe S(ale Con(rac(ors La�v 18.27 RCW and <br />2962G0 WAC. r, _ <br />�23- iY <br />�+rvism oeoe¢oia <br />,'c gY ✓GS . , <br />F[E <br />PERM�# <br />E ► �-(�l6 � D � <br />