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� � <br />ELECTRICAL PERMIT �►PPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />6 y�� I4ti d Q�- , c�-�.-� � A <br />PROJECT ADDRESS <br />0�� <br />Tenanl <br />Electrical Contractor <br />G �iv l-1; <br />Mdd Atldress <br />Mail Atltlress <br />Mafl Address <br />��� i« ��l <br />S�ate License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />�.�Eve� �1�� <br />�i�y SlatelZ�p <br />Ciry StatelZ�p <br />Cdy <br />StatelZip <br />Phone <br />Phone <br />Phone <br />�l��d -� 31Z�Is <br />City of Everefl Business License umb r(requued) <br />�asv �' _ <br />Contracl Price ol Work <br />Contact Person/Contact NumbedEmail <br />Number o( devices Qf low voltage) <br />L( , .� <br />Descriplio� ol Work to 6e Done: �'�( TC*� Gi � A�(y � i� U�er G� r G� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily fhal 1 have read and examined fhis app�ication and know fhe sarne !o be tn�e and <br />conecf. !1R provisions of laws and ordinances goveming (his type ol �vork a�ill be complefed <br />whe'her specr(ed herein or nof. The granUng o! a pemiif does nof pmsume to give aufhority (o <br />violate or cancel tl�e provisions ol aoy_o!I%i sla(e or /ocai la�v regulating constn�clion or fhe <br />pe�fonnance o/ construction. That I am aufhonzed by fhe o�vner ol fhis propeAy to peAorm fhe <br />�vork for �vhich application is made and 1 complV wilh fhe Stale Contractors Law 18.27 RCW and <br />296.200 WAC. <br />, ��ay/dv/S <br />gnature Date <br />r.eviseo asvsrtoi+ <br />FEE <br />� �Oc� <br />PERMIT# <br />E�5�3- l�� <br />