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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />l�i� Ra,�,�� A� ��-�,qgzc�i <br />PROJECT AODRESS <br />�' a9`�y <br />C Jl��i��167 <br />� �be,r-�" �-ra.�� 1�11 ����� (�ve, �„�r�tf�,Wo. �-1$20I y2S-3�z-96Yy <br />Owner Ma�lAddress Clry State2ip Phone <br />Tenanl <br />Mail Address <br />Ciy <br />Slate2ip <br />Phone <br />Ow�er _ <br />EleclricalConhaclo� MailAddross Ciy Slato2ip Phono <br />Stale License Number (required) <br />I �Sg�1 sF(L. <br />Proposed Use of Bu�l ing <br />Square Footage (If residential new conslruction, remodel or additian) <br />Nwnber of devices (I11ow voitage) <br />Descriplion of Work to Be Dono: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />City ot Everett Business Ucensn Number (required) <br />Co�tract Pnce ol Work <br />Contacl PersonlContact Num6edEmail <br />f hereby cortily fhaf I have read and examined fhis applicafion and know fho same !0 6o fruo and <br />corroct. All provisions ol laws and ordinances goveming fhis typo ol worlc will bo completed <br />whefher spocifiad herein or not. The granling o/a permif does not presuma fo givn a�fhody to <br />violafe or cancel the provisions o! any ofher sfate or local law iegulating consfructi�n or the <br />peAormance o( construction. Thal I am authonzed by the ownor o/ fhis property to peAorm fhe <br />work !or which application is made and 1 comply wifh the Sta(e Confractors Law 78.27 RL'W and <br />296.200 WAC. <br />�Sf2�[1 <br />REN5E0 �aTNV i. <br />FEE <br />g0°o <br />PERMIT# <br />E1�40B�-1C�1 <br />