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� <br />� <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everett+va org <br />��O�S �-f�nr-t �6L,e , � Uef�,-tt <br />PROJECT ADDRESS <br />�AA �li .. I i 1.00-LI _..._I `V��{�i <br />Tenant <br />Eleclrical Coniractor <br />MA-Sn���o s� �a <br />State License Number <br />Proposed Use of �E3w mg <br />Matl Address <br />Idail Adticess <br />Address <br />Squ� e Fo�ol ge Qf residenGal new construclion, remodef or adAilion) <br />Number of devices Qf low vollage) <br />Description o( Work lo �e Done: <br />�i �� n9 ���q rd�( e <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cily <br />City <br />State2ip <br />SlalelZip <br />u -���-�3 <br />�.�w I 3 0 -�3 <br />�`1 0 . � <br />Contr ct Price of Work <br />Contact Person (Plan Review) <br />1 hereby ceiirly Ihaf 1 have read anAexamined fhis applicalron and know the same to he Inie and <br />correcl. All provisions o(laws and ordinances goveming this lype ol work will he completeA <br />whefher specdied nercin or nof. 7he granhng ol a pennif does not presume to yivc aufhr.nty fo <br />violale or cancel the provisions oI any olher s(ale or local la.v �egulafing conshucfion or (he <br />pe�fomrnnce ol consbucfion. That I am aulhonzed by fhc owner ol (his properiy fo peAorm the <br />worN lor which apphc��hon is mado and I comply �a�rlh the Slale Confracfors Law 78.27 RCW and <br />296.200 ✓VAC. // <br />�---- �-( -- (S o2U 13 <br />RLV�510 YJO/1 J <br />Phone <br />Phone <br />Phone <br />fLE <br />�g 50 <br />PERMITJt <br />i30Q-� b�3 <br />,�—__.----- <br />