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ELECTRICAL PERMIi APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everethva.org <br />�, r � � Z .. <br />- __!► + <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical Contractor <br />tvtail Address <br />Mail Address <br />�C. <br />tvlail Address <br />. <br />Ts�� �� l �g �s <br />State License Number (required) <br />Proposed Use of 6uilding <br />Square Footage (If residenlial new construclion, remodei or addltion) <br />Number ol devices (I( low voltage) <br />u <br />City <br />Gity <br />Cdy <br />(� --(�-iS' <br />E ��� �'"� z ` <br />Slate2ip <br />Stale/Zip <br />State/Zip <br />Phone <br />Phone <br />Phene <br />D��O� <br />City of Everetl Dusiness License Number (required) <br />�OD�' <br />Conlracl Price of Work <br />Conlacl PersonlContact NumberlEmail <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hemby certi/y fhat 1 have read and eramined fhis applica(ian and kno�v Ihe same fo be fnre and <br />corrocL FlII piovisiais ollaws and oNinances gaverning Ihis fype ol worh �ci116e completed <br />:vhelhcr speci(ed hercin or not Thc granfin� ol a pem�if does not pmsurne to give aulhonty to <br />viula(e or cancel the provisions o(any ofher slale orlocal lav� regulating consfrucfion or the <br />perfonnance a/constrtiction. That 1 am aufhorized Gy the o�vnero/this property fo perfonn fhe <br />�vo�k lor which npplication is made and 1 compty �vifii fhe Stafe Contractors Law 18.27 RCDV and <br />296.200 WAC. <br />REWSbOGflL'6?OIJ <br />FEE -- —� <br />V/ � . �� <br />PERh1ITn <br />E l 5a(�- ( a� <br />