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� � <br />ELECTi RICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />/` �1 � ���Jl <br />L( �., -f�t" , � <br />/ � � � CSl"icitG �� � �vrrt . 6v..� l � <br />PROJECT ADDRESS <br />Uwner <br />T �nant <br />ctectrical Contiad�r <br />Sta�e Licenst Number (required) <br />Re,tfu/ <br />Proposed Use o` Building <br />/ �X_ <br />��iail �adress <br />I�tail AdUress <br />tdail Address <br />�.1� <br /><r� �t <br />C�ty <br />Gty <br />C''Y <br />Squarz /-�� residential new wnstruction, remodel or addition) <br />Number o1 deviws (If low voltage) <br />Descnption of Work lo Bc Done: <br />� t�! ,i0 , .� � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />u.�, YY2su f�.2s��2 <br />State2ip Phone <br />StatdZ�p Phone <br />StatelZip <br />Phone <br />City ut Everett 6usiness Ucense Number (required) <br />Contract Price ol Work <br />Contact PersonlConlact NumbedEmaJ <br />I hereby certily lhat 1 havc read and eA�amined lhis applicahon and know fhe same fo be lrtie and <br />correcL All p�owsions olla�vs and ordinances governing (his type ol ivo�k will be complefetl <br />�vhether specdied hercin o� no1. Thc granGng o! a pem�d does nof presume to give aulhonty fo <br />v�olate or cancel the provisions ol an}� other sfafe or local law regiduting construction or the <br />perfonnance oI constn�clion. Thaf I am authonzed by the o�vne� of fhis property !o peAortn the <br />�vork lor �vhich applicafion is made and I compty uath fhe Sta(e Contractors Law 18.27 RCW and <br />296200 WAC. <br />Fcv15EDOPN6QOIJ <br />F[[ <br />7S � <br />PERMITK <br />E�503 - II �o <br />