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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 />/ I �s C(G�i �BSO� �, Sfe: g <br />PROJECT ADDRESS <br />,�Ie��r <br />Owncr <br />i� SA�u� <br />Tenant <br />h!ail Address <br />�E�uc,l,A ��(os <br />b'ad Address <br />�-yoo Nur�laso <br />t.tail AOtlress <br />13���yNC(�$5L3 <br />State L�cense Number (requved) <br />Proposed Use of Building <br />Gry <br />� iL.� s�e-.6 <br />Cily <br />h .EdQ,�� <br />C�ry <br />Sauare Footage (If res�dential new construction, remodel or addihon) <br />( <br />Numbcr of device5 (II low voqage) <br />IDescnption ol Work to Be Done� �^ �' F— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />SlalelZlp <br />Stare2�p <br />si�ieiz�o <br />(�/�s—/.�3a- y,�� <br />Phonc <br />'�ao3 `i� S/3•0�/d <br />� honc <br />Sa�3 �y�)��G�'�! <br />P�ane <br />1 <br />o� y�x6 <br />Gty of Everett Busmess L�cense Number (reqwred) <br />�Io� <br />Conlract Price of Work <br />(ilAke. <br />Contact Person/Contacl Number/Email <br />I hereDy certdy Ihal 1 havo road and axaminod fhis appl�whon and know fho sama lo be true and <br />cor.ect. Afl provisions ollaws and oidinances govoming fhis typa ol work will be complefed <br />whefher specrfied herein or nof. The granfmg ol a permd docs nof presume fo givo aufhonty fo <br />violate or cancel tho prowsions o/ any olher stato or local law regulaling consfrucbon or fh9 <br />peAormanco o/cons(ruchon. That I am Buthorilod by the owner o/ fhrs proporty fo peAorm fho <br />woik lor �vh�ch appGca�ion is made and 1 comply with Ih� Slafe Confracfors Law 78,27 RCW and <br />zss zoo wnc. <br />�// <br />ISignal <br />I <br />c( wSEO OF'N.'J Ia <br />FEE <br />��� <br />PERMIT# <br />Ef�{lU� lz <br />