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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 />5JI I {�iGrbow i..vnc.+ 1=bQhf�� %l�� �cS'�03 <br />PROJECT AODRESS <br />Owner <br />Tenanr <br />S►►I <br />Meil AAdress <br />G1ad Address <br />SO�w� scl ar " 0� �TG <br />Contractor Mail Address <br />��fr��SS �r��% r� <br />Slale License umber (required) <br />Proposed Use ot Building <br />S <br />Square Footage pf residential new construc6on, remodel or atltlilion) <br />Number of devices (If low voltage) <br />Description of Work lo Be Done <br />�`—, z_ • •• • � • � <br />Ciry <br />Ciry <br />y��?o3 <br />Stele/ZiD Phone <br />StalelZp Phone <br />Serc��c. l,� d ��i►y� �06 • 706 � /53 <br />C�ry State/dp Phone <br />oyQsy� <br />Ciry of Everett Business License Number (required) <br />:�/�. 6 So. za <br />r Contract Price of Work <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certdy fhaf 1 heve n <br />correcf. A/l provisio ol le� <br />whefher sp�cAied h ein or <br />violafe or cancel t provisi <br />peAormance ol sfruc!� <br />work lor which plicetio r, <br />25b 200 WA . <br />C�,�,s �oti�,�;�� -ao�-�d6-,�3� <br />Contact ParsoNContac umbeuEmail <br />C jo�A�q, � �` �i"Sow�dSol�.,,, Com <br />�1 end exemined fhis application end know the snme fo ba lrue end <br />and oMinances gaveming thra Ivpe ol work wdl be complsfed <br />t. The granfing o/a permif does nof presume fo give aulhonfy fo <br />s ol any olhe� ,ste�e or local law regulahng consfruction or the <br />That I am av(horized by the owner o/ this p�operty to peAorm the <br />�adg8nd�%omply with fhe Stete Contractors Lew 18.27 RCW and <br />�!/� a-�g-,� <br />— Signature Date <br />REvI$Eo040640fa <br />FEE <br />��°° <br />PERMITA <br />� c��z—�38' <br />