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�_ � — ---- <br /> � ELECT�ICAL PERMIT APPLICATION <br /> CITY O� EVERETT PERMIT SERVICES <br /> 3200 t;EDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —wnvw.everettwa.org <br /> I <br /> I' � / <br /> G2� a-'� �P in/1 /7� <br /> PROJECT ADDRESS <br /> l�ot� �� P /Lf �Si�r 3���/ /� or�,�ve SZ S�o�or��sl� /�i� yas'33y `�/33 <br /> IOwner �dadAddress C�ly State/Z�p Phone <br /> � N�N� <br /> Tenant t.tad Add�ess Gty Sca1clZ�p Pnone I <br /> N�� I <br /> � StatelL Phone � <br /> [I¢CtrCalCOnlraclOt L1adAdtlress Cny P <br /> i Sa1e License Number(requucd) City of Everett Busmess License Number(reqwred) <br /> I I <br /> i <br /> �i Proposed Use oI Duild�ng Contract Pnce ol Work <br /> I <br /> Square Footaye(I(resideM�al new construction, remodel or addition) Conlact PersonlContact Number/Email <br /> NumL•er ol devices QI low voltage) <br /> / ��'�,I Description ol Work to Be Uone: ����GG�i 0%1 �� ���'� . �U-��� S � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � ` � <br /> f <br /> 1 Ireicby cerh(y lhal I Rave read and exanuned fhis applicafion and know U�e same to be tnie and <br /> cormct All prov�s�ons o/latvs and ordinances governmg lbis fype ol work�vil!be ComplBled <br /> �vhether'spc�ifcd hercin or noL The granfmg ol a permR does not presimie to grve authonty to P[RMII« <br /> violate or cance!the prov�sions o/any ofher sta(e or localla�v regula6ng construcLon or fhe � I� O � _ 0`7 O <br /> peAorrrrance ol constn�clion That I am authonzed by the owner o/this property ro pe�fomi fhe �— <br /> work lor ivhich applica(ion is made and I comply wdh fhc Sfate Confractors La�r 78 27 RCW and � <br /> 296.200 WAC. <br /> � Q ��,�--� r��/� <br /> 5 nalure 'Dal <br /> FEVISEOOB�J6401: <br />