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�ECTF�AL PERMIT i4PP�ATION <br />ERMIT SERVI ES <br />CITY OF EVERETT P / <br />' 3200 CEDAR STREET, EVERETT, WA 98201 g--D�o "�� <br />_: 425-257-8810 - FAX 425-257-8857 - vnw+.everettwa.gov �/SO n�a'"� <br />X <br />� <br />..' �;- <br />� Y' / � <br />°. l� �� , G v� r�ll <br />I l�� = �� - <br />PROJECT ADDRESS : � <br />(' 1-�� r M ��� �l h ��� <br />Owner <br />Ma�l AdOress �'N <br />� <br />Tenant <br />Electncal Contractor <br />State License Number (required) <br />proposed Use of Building <br />Mail Addmss <br />Mail Aadress <br />c�ry <br />Cily <br />Square Footage (If residential new constradion, remodel or adddion) <br />N �- <br />tJumber of devices (If low vollage) <br />/ /�,,.�'..-{-� � <br />Descnplion ot Work t�8e Done. <br />P, <br />� <br />�ii A , `����1 <br />"I !�'/ � J '7 '/ " <br />SlalefZiD P�one <br />State2ip Ahono <br />State2ip Phone <br />Ciry of Everett Business License Number (required) <br />Contract Pnce of Work <br />Contact PersonlComact NumbedEmail <br />V <br />CITY OF EVEREff LOCAL SALES TAX CODE IS 3105 <br />1 homby cortdy Ibof � havo �oad and oxemrnod fhis applicafion and know fho samo fo bo Imo nnd <br />corrticl. A�� P���sions o! lews ond ordinnncos govoming Ihis fype of work will bo complofod <br />wholhor specifiod horom o� nof Tho 9mnfing o( n permd doo: not pmsumo lo g�✓o nuthonty fo <br />violefo or cencel fhe prowrions o/ onu olhor slalo or local law m9u��hn9 consfn�c6on or Iho <br />po�fortnnnce o/ consfruclion Thaf 1 am uufhonzod by fhe ownor o/ fhis prnporty lo porform fbo <br />work !o� whi h aophcafion is made and 1 comply wrth Iho Staro Confracfors Law 18.27 RCW and <br />296 QO C � / <br />� <br />���///��JA/ M,�1��� /1_ W��� ----��-'��- <br />" '"/ I V '"_/ `� Datc <br />Signalum <br />FEE �1 <br />�� V4� <br />P[RMCfIt <br />E lSD�j - D2� T <br />� <br />arv�u.uannvsoie -. _'_____'_--- <br />___ _. ____-- _.. <br />