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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREl'f, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereltwa.org � "I'7 --�C� <br /> t=l4c'�--c`'3/ <br /> LZI�o t'iv�.�.c� �- <br /> PROJECT ADDRESS <br /> .����-F' .�xr�IS Z`�a`6 (R�, �,ut-�-r�,c,�-f �-Q . �(ZS sd� 6� 7 <br /> Owner Ma�l Address Ciry State2�p Phone <br /> Tenant MailAdaress Gty Slale/Lp Phone <br /> N�Nl�-1� ��L'�'n L `� 13 'f IC'�i.LE� /it2.✓�J��1KAA/�C,l �A �li `7 7)Z O Li <br /> Electrical Conlractor Mail Address C�ry Stale2lp Phone <br /> ��a_7z2 . 69� D <br /> l�VI�L()F<L�'��G�� �t �OP�:SS <br /> State License Number(required) Ciry of E�erett Business Llcense Number(required) <br /> /�a a <br /> Proposed Use of Building CoMract Price of Work <br /> Square Foo�age(II residential nerl conslruc�ion,remodel or adddion) Conlac� Persom'Contacl NumbedEmail <br /> Number of devices (II low vollage) <br /> Descriplion of Work to Be Done� i"I/Lc.(��t.l.� �--�- �1 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 �G, ��. <br /> 1 hereby certi/y fha(I have read and examined Ihis application and know fhe same!o be We and <br /> corecf. All piovisions ollaws and ordinances goveming Ihis type of woAc will be compfefed <br /> whether specified he�wn ornoL The gnnting o/a permit does nof pmsume fo give aufhonty to PERMCf� <br /> violate or cancel fhe proWsions o!any ofher slate o�local ��v regulating consfruclion or fhe � / <br /> peAom�ance ol consWcflon. That I am aufhonzed bylh�ownerolfhis property 7o peAomr fhe E � � U � ��'o <br /> work for which applic�C s made and 1 comply�rRh( � Sfate Contracfors Law 78.27 RCW and <br /> 296 200 WA <br /> < 9����� <br /> Signaturc Date <br /> Feviseoowveoia _ _ <br />