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ELECTRICAL PERIVIIT APPLICATION <br />CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.ory <br />! � l �t� � �� �-� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Eleclrlcal Contractor <br />�wj /�J,� <br />/ htail Address <br />Mad Address <br />�„� c S10 <br />Mail Address <br />City <br />C �� � � � � � ZZ��-� <br />State License Number (required) <br />��1r��V4A U�e <br />Pr posed Us of Huilding <br />J Cr� <br />Square Footage Q( residential new construction, remodel or addilion) <br />Number of devices Qf low voltac�e) <br />r❑ <br />StalelZip <br />SlatelZip <br />State2p <br />Phone b� <br />Phone <br />�3�3� <br />Phone <br />c��lie� � <br />Gty of Everett Business L�cense Number (required) <br />Conlract Price o( Work <br />Contacl Persen/Conlact Num6edEmail <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />1 hereby certdy thaf I have read and e.ramined fhis applica(ion and know fhe same fo he frue and <br />corn�cf. All provisions o/la�vs and ordinances govemin� lhis type ol v:ork �a�ill be complefed <br />whefher specdied heiein or noL The granting o! a pemnt daes nof presume to grve aufhonty ro <br />vio�afe ur cancel fhe provisions ol any olher sfate or local law regulating constn�ction or fhe <br />perfonnance o/ consfn�ction. That I am aufhonzed by Ihe o�vner ol th�s property lo peAonn !he <br />�vork la �vhir(i app�fy7l�on Is made and 1 compty with fhe Sta(e Contracfo�s Law i8 27 RCW and <br />REVISED 0905201J <br />FEE <br />7s�= <br />PERMITti _� <br />E l t-I D- �(o ( <br />