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ELECTRICAL PERMIT APPLICATION <br />ClTY OF EVERETi PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42.5-257-8810 - FAX 425-z5�-8857 —�^�•everelM'a.org <br />( � � �� e � �v e2 e_�� �J (� q �aO� <br />� a l a. �,U I�l a��ri� � �,� <br />PROJECT ADDRESS <br />olvner <br />Tenant <br />ElectfiC01 ConV9ttOf <br />Mail Addtess <br />A9ail Addross <br />Mall Addrzss <br />S -L �D3 I � <br />State I'cense NumUor <br />s i � a-�-r�ic�� <br />PropOSed Use of Bullding <br />Square Footagel (�f �siden�ial new construc6on, remodel or nddiUon) <br />!v /I"� <br />Nuin6er of davices Qf low volta�e) <br />CITY OF EVERE7T LOCAL SALES Td%CODE IS 3106 <br />ciry <br />Ciry <br />Stole2lp <br />stateZp,t/ �IU7 � <br />r1�-t� • r � <br />S�ate/Z�P <br />anone <br />Phone <br />�i � � J�ob <br />Contract Prite of Work <br />,J � r� `�i �_� r�c� <br />Contact Person (PIAn Review) <br />� <br />I horsby ce�fify that 1 have rsad snd examined this applicetion and know O�e same to be true end <br />correct. All provisions of laws and ordinances yoveming this type of work �vill be complefad <br />whefNorspeciCed horoin or noL Ths grsnNng o� a permlt does not p�osumo to g�vo authonry to <br />violafe or canccl the provisions ol eny other stefe or local lew �egulsfing constructio edonn Lhs <br />perfomiance o(corsfruc6on. Thaf 1 am authodzed by the owner ol this propedy fo p <br />vmrk lor wh;ch appllCation is medo and 1 comply with the State Contractors Lsw i8.27 RCW and <br />246.200 WAC. , i <br />