Laserfiche WebLink
� - - - --- ------�---------- — ---- �--- -- <br /> � ELECTRICAL PERMIT APPLICATION <br /> i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — v✓wea everettwa.org <br /> I�I l�3\ G�2A,�� A�� #l03 �er�`�� (�/� <br /> i PROJECTADDRESS <br /> I A�:ta ��So�^ la�l C�-��� R� ��(03 �ie�� 1.�� a�� H25�z52-`i <br /> � OWner h1aJACd�ess Cdy State/Lp P�one <br /> TenaM ��tadACtliess Ci;y Sta7e2�p Pnone <br /> �c�n �lec�/.� f�4l.{S�;II2 WR `�b�0 '-�`�S-�`��'SS� I <br /> � Electncal Contractor hlad Atldress C�;y Sla�e�Zp Pno❑e <br /> �,�:��e��lo�� D5z55 � — <br /> I Sta1e L�cense Numbe (reawred) Cil�erett Business License NumUe• (reGi�red) <br /> �Q� <br /> � — - �Pn ��i il,� ��i� <br /> � � <br /> I Proposed Use ol�uildmg Coniract Pnce of Work <br /> I <br /> ! Y �e, c<�z���� �c� z���c�s s_� I _ <br /> �, Square Foolage(If residenlial nev+ con,lruction, remodel or aCdd�on) nlacl PerSONCon'act NumberlEma�i <br /> I <br /> Nwnber of devices(11 low vultage) <br /> I Descnption of Work to �e Oone: [�t�Gl ��� �"'''�� "� ���� `� �`��—������ ���� <br /> I --- -- — <br /> I -- <br /> FEE <br /> '. CITY OF EV[RETT LOCAL SAl[5 TAX CODE IS 3105 �, <br /> � !hc�cby r.eridy tlraf I h,rve rcad and exanuned(lus application and I<nou�the sar.�e fo Ge tn�e and _ ___ <br /> conect �II proasions ollaivs and ordrnances goveminy this (ype o!�a�orlc�vill be wmpleted – --�-- <br /> �vhelher specdied herein or noL Tlre grantmg ol a pennd rtoes nof presurne fo groe aufhonty fo PERMIT« � <br /> violafe or cancN the prow5ion5 0(any other 5tafe Or loCal law regulafing ConsbuCtion or fhe E I 5 D�-e:YXo <br /> perlonnance o/consfruction. That 1 am authonzed by fhe o�mer o/this property fo perlonn Ute <br /> n�ork!or�rluch applicat�on Is made arrd I comply�wth thc Sfatc Confractors Law 78.27 RCW and —__ I <br /> 296.200 WAC <br /> �� � � < <5 <br /> Sign 1'ur�e �. � Datc <br /> �� cF�'�crJJc?:.�iy . ----_____— _ _" <br />