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ELECT�CICAL PERMIT APPLICATION <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 />I`-I )1 I--+ 0��r � i��-r_1= 'G-_ <br />PROJECT ADDRESS <br />6 i <br />Tenant <br />Mail Address <br />Mail Address <br />Cily <br />Ciry <br />State/Zip <br />Slal>/Zip <br />`1,�5 - 75`f-7��. <br />Phone <br />Phone <br />I )•1-I�- I� I,cGTIL�G ! �'j'o�: .�-!l i L%� ,cu� l -'^ �%�rt^.�G� -'J � - %4.�-7�'i'/ <br />Eleclrical Coniractor Mail Address City StatelZip Phone <br />c �� <br />(��L��r�k�%%o��i� ' ���i ��- <br />Stale License Number Coniract Price of Work <br />/ i ��•v (� riuior'uZ; k6 -75j /�121 <br />Proposed Use of Building � ' Conlact Person (Plan Review) <br />/ � <br />Square Footage Qf residential new construction, remodel or addition) <br />�_ <br />Number of devices (If low voltage) <br />Description of Work to Be Done: _� � �`�� <br />� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� liereby cerlily fhaf 1 hace read mid examined fhis spplication and know the sarne to be true and <br />cmrecL All pro�isions o/la�vs and ordinances govaming this fype u( work will Ue compfefed <br />whether specilied he�cin ornoL The granling ol a pe�mit does nof presurtto to give authonty t� <br />✓iolate orcancel (he provisions o/any othcrstafe orlocal la�v regulatiny construction or the <br />perfonnance ol constn�ction. 7hat I am aufhoiized by the o�vnero(this propeAy fo per/onn the <br />�rork /or wtich applicafion is made and 1 comp/y �vifh fhe State Confractors La�v 1827 RCW and <br />296.200 WAC. <br />I �, <br />Sigi <br />r.r��,sr:� s¢ona <br />�Ci �G—�� <br />FEE <br />���poo <br />PERMIT# <br />E ���D-a�$ <br />