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� � <br /> ELECTRICAL PERMIT APPLICATION <br /> C{1'Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 25G�O ����SG�i <br /> PROJECT ADDRESS <br /> I-1AA�K 6�S «��S <br /> Owne� Mail Address Ci�y State2p Phone <br /> Tenant Mail Adtlress Cily Stale/Zip Phone <br /> Sur�m�T �L��"l'�c, iNc 6i3`� Z.�iSr Sl' Nc� S,�Nwao,O W� �ib24^� <br /> Eledrical Contractor MailAddress Cily Stale2ip �n� �� CP,�� <br /> w � <br /> � l Oo0 ��"L o5� 2� �O <br /> Slate License umber (required) Cily o(Everett Business License Number(required) <br /> S�'(� ti 5�U <br /> Proposed Use of Building Contract Price of Work . <br /> i�s� l.Ee �2S 30� S�S� _ <br /> Syuare Footage Qf residential new conslruction, remodel or addilion) Conlacl Person/Conlacl NumbedEmail <br /> Number of devices(If low vollage) <br /> Description of Work to Be Oone: �il 1� �� 5��' �� �M� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 y� �`�`-' <br /> (/ <br /> !he�eby cerfi/y thal 1 have read and examined this application and know the san,e lo be true and <br /> conecf. All provisions ollaws and ordinances goveming fhis fype ol worlc will be complefed —� <br /> whefherspecilied herein ornoL The granting ol a permit does nof presume fo give aufhonty to PERMIT# <br /> violate or cance/(he provisions o/any ofher stafe orlocallaw regulatinq consWc(ion orlhe e � ( � 0(? , �O � <br /> peAoimance of consWc(ion. Thaf I am aufhonzed by the ewner o/this propeRy to peAorm the �_, `'f b <br /> work lo�which application is made and!comply wifh the State Confractors Law 18.27 RCW and <br /> 296200 WAC. <br /> � �^-- A�G � � 2��y <br /> Signature Dale <br /> REVISED ONN620f a <br />