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ELECTRiCAL P�RMIT APPLICATIOiV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —�vww.everettwa.org S— I% —�3 <br />E-13o5-I� <br />J- �. j_� i� � C 1� ��; �"P t' �l i t.,r= '1 2,1��� <br />PROJECT ADDRESS <br />I 'i � � l�- "'�, t , ��; ( ' i l'�� �i l �( I L � ° ;'_ �� -( ��� r� ✓ � �, �- i � - > � ', L �� � i"� t� i i �•-� i� -i %: -` <br />O�tiner Mail Address City Stale/Zip Phone <br />� : . —� _ — <br />Tenan� <br />? V'�) r� �;X <br />� E:lectrical Contractor <br />State License Number <br />Mail Address <br />Mail Address <br />I _, �. F� <br />Proposed Use af Building <br />I <br />II, �3quare Footage (If residential new construction, remodel or addition) <br />i iJumber of devices Qi low voltage) <br />Descrip0on of Work to Be Dona: ��- I l�� '� - h' � <br />City <br />City <br />( <br />StatelZip <br />SlalelZip <br />Contract Price of Work <br />1.�2�_ .i i � � �< , <br />Contac! Person (Plan Review) <br />fEE <br />'. CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �%L� C l_ ) <br />� <br />I 1 hereUy certily that I have read and examined this application and know the same to be frue and <br />i conrct All provisions o/laws and oidinances goveming this type ol work will be complefed <br />r:hether specdied herein ornot The yranting o/ a pemiit does not presume fo give authority to FERh1IT;t <br />I violafe orcancel the provisions of any other state or/ocal law: egula(ing consWcfion orthe <br />per/omim�ce ol canstructio��. That 1 am nuthorized by the mvner o(this property to peAonn the E� jL�J - � C' �" <br />irork !or �vhicb application is made and 1 comply with the Sfate Contractors Lew 18.27 RCW and <br />' 296.200 Wl1C. <br />Phone <br />Phone <br />„ �i. .' _'/ _,�,. <br />' i <br />— � ' Date <br />Signatute . <br />Sr � a�titP���l�� c,�/��c4� un GK�rc[cPa� `�v <br />