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ELECiRICAL PERIVIIT' APP�ICA�'��N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REET, EVEFETT, WA 98201 <br />425-257-8810 - �AX 425-257-8857 — www.everettwa.org <br />� <br />PROJECT ADDRESS <br />Owncr <br />Tenanl <br />Eledrical Contrector <br />Mail Addiess <br />Mail Address <br />�J o <br />Mail Address <br />c1�,-1� ��. o���� <br />Stale License Number (requued) <br />Pwposed Usc of �uilding <br />Square Footage Q( residenlial new conslruclion, remcdel or addition) <br />Number of devices (If tow voltage) <br />Cily <br />City <br />SlatclZip <br />State2ip <br />Phone <br />Phone <br />_ .Sh�.w��� w�f- I�Zr2 _ <br />�ity Stale/Zip � Phone <br />C,� bi �Zo—ts� <br />�3��sC <br />City of Everel� Business License Number (required) <br />Contracl Price o( Work <br />Contact Person/Contact NumbedEmad <br />Description o( Work to Be Uone: �P_/�rl�_______1��L,J(�-�_._�01 �,_. <br />CITY OF EV[RETT LOCAL SALES TAX CODE IS 3105 <br />I hcreby cerfily fHat 1 havc �cad and examinr,d Ihrs apPlicafion and Imrnv Ihe samc fn he Gue and <br />correr.L All provisions o/laws and ordinances govemin� (his fype ol worl< will be completed <br />whr,ther specilied herein or noL (he gianling o/ a pennif does nof prr.sumr, fo �ivc aufhonty fo <br />violafe orcancel fhe provisions oI any nlher slafe orlocal law �egu/aling cons(n�ction nr the <br />pr.ifonn.�nr,e ol consfrucfinrr. That I am aulhonzr.d by (hr, owner q/ fhis property fo pedorm Ihe <br />worlr lorwhiclr applicafion is madc and I compty wifh Ihe Sfatc Contracfors Law 18.27 HCWand <br />296.700 W/IC. <br />i n / � <br />lD =��--- <br />o„� <br />NCVISCO00�0!iROtJ <br />F[G <br />�D � <br />PFRMii tl---- ---- <br />E ,�FI o--�8"� <br />