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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.everettwa.org <br />� �2 � ��,�J �,� <br />PROJECT ADDRESS <br />I/t� <br />Owner <br />Tenant <br />(j c,.� �.¢.J� <br />Elecirical Coniractor <br />Stale License Number <br />� 1_' � <br />Proposed Use of Building <br />� C� �'i� n ZL�� Z <br />Mail Address <br />Mail Address <br />Mail Address <br />Square Foolage (If residenlia� new consiruction, remodel or addition) <br />Number of devices Qf low vollage) <br />Description of Work lo Be Done: � ���t�� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />6- ao--i3 <br />G► 306--1�f`L <br />> k, cI �U� Z- <br />State/Zip Phone <br />Sta:elZip Phone <br />Stale2ip <br />Conlracl Price of Work <br />Conlact Person (Plan Revieer) <br />1� 2 p �+��L <br />I hereby cerfily fhat I have read and examined this application and know the same fo be true and <br />conect. All provisions o( laws and oidinances goveming fhis type o/ work �vill be completed <br />�vhefher specilied he�ein ornoL The granting ol a permif does not piesume fo give aidhority to <br />violate or cancel fhe provisions o/any other s(ate orlocalla�v regufafing consWcfion or the <br />perfomiance a/consfn�ctiai. That 1 am authoiized Uy the o�vnero/this propeAy fo perfomi the <br />woAc lor �vhich applicafion is made and 1 comply �vifh the Sfate Confraclors Law 18.27 RCW and <br />296.200 WAC. <br />--�— <br />_---� _=-� <br />" �Sianature <br />�-� c,e��t�i:;��n <br />L-Lc�-�� <br />Phone <br />FEE <br />� `� �� <br />PERMIT# <br />E � h�:� - ( ���� <br />