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�� <br />ELEC�'RICAL PERMIT APPLICATION <br />CITY OF EVEREIT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />�. <br />i� ��' % N arJ��S->r f� � <br />PROJECT ADDRESS <br />Owner <br />Mail Address <br />City <br />State2ip <br />Phone <br />�� i Yl b'(' Li. Cl%C � v� p-1�1 <br />Tenanl Mail Address City State2ip . Phone <br />Vr� FIP��r;e `������ <br />CoNraCtor Mail Address <br />�`����ralel 4m33�� <br />State License Number <br />Proposed Use of E3uilding <br />Square Footage (If residenlial new construction, remodel or addition) <br />Number of devices (If �ow voltage) <br />Description of Work to Bo Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Ciry <br />G� <br />i -7,� - �.L <br />Phone <br />SL�� � <br />Conlract Price of Work <br />Contacl Person (Plan Review) <br />��tC�n. <br />I hereby certiry that 1 have read and examined this application and know fhe same fo be true and <br />conecL All provisions ollaws and oidinances goveming fhis type olwork �vill Ue comp/eted <br />wfiether speci�r,d Aemin or noL Thc granfing ol a permit does not presume fo give au(honty to <br />vio/afe orcancel the provisions ol any others(ate orlocalla�v mgulaling construcfion orthe <br />performance of construclion. That I am authorized by fhe o�vner o/ fhis prope�iy to pedonn fhe <br />work (or whicl,i-application is made and 1 comply wilh lhe Sfate Confractors Law 18.27 RCW and <br />296.200 WAG, ! ; <br />a <br />r.Fwsrn.vlani <br />i-,,�-�-J <br />C+ h <br />FEE <br />�-7�0 <br />PERMIT� <br />E 13c;� - I�� <br />