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� __ ------ <br /> ELECTRi�AL PERMIT APPL�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> � <br /> �,-� S�j _o2 <br /> a3a-� P�' �/ q a-,s <br /> PROJECT ADDRESS <br /> n,, u I� � r.�� �.n� '�� >�.3 �� <br /> 0'.vner •'.'all l,Cd'ess City � Statc2�p Phonc <br /> Tendnl t.tai!Acdress City ' Stale2ip Phonc <br /> Cm �eatinu (ncr I�l�i �rc�du�wa C-��� WR 98�.oi �z5 2�9 c�t��� <br /> Electnc5l Centractor M14�1 Aadress Ci'y State2ip Phone <br /> Gm�i�4g�lb� � oi (�o9R <br /> Statz '_icense Numter (required) Cily of Everett Busness License Number(reqmred) <br /> a�c� _ <br /> Proposed Use of Buildmg Conlrect�Price of�:�ork <br /> . <br /> �Ph�� 25 ZS�1 (do� <br /> Square Pootage (If residential ne.v construction, remodel or addilion) Contacl Person/Canlact NumbedEmail <br /> Num6er of devices (If low vollage} <br /> Descriplion of WorA to�e Donc �j1 1 Il�i II �l� <br /> I iFEE <br /> � I ^ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 i� �D D j <br /> � <br /> 1 hereGy certi/y Ihaf 1 have read nnd exarnined lhis applicahwi and hnow fhe same fo be f�ue anJ <br /> correcf. All pruvisions ollaws and ord6iances gaveminy this type o!�rork will be complefed <br /> �rhe(her specified herein ornot The granfing o(a pennit does not presume to give aufhonty fo PERh11Ti�' <br /> violafe or cancel the provisions of any othersfate orlocal lmv rngula(ing consfniction or Ihe <br /> perfonnanco o!consfnu(ion. That 1 am aulhonzed by the o�yner ol Ihis propeAy to pedonn fhe E 'S�'Q I <br /> work lor which applicafion is rnade and 1 conip/y with fhe Sfate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> I�,bla1.� ��C l � �� <br /> Signature Oafe <br /> a=:;s_ncso�:ou _l <br />