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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERE7T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42�-257-8810 - FAX 425-257-8857 — �w�nv.everetlwa.org <br />22,22 2��nt�r ,4��E ����E�-�- (�J� ��2G1 <br />PROJECTADDRESS <br />Ovmer <br />Tenant <br />Eleclrical Co <br />�('�oM E ,� K9 �/�i96 <br />Slate License Number <br />.`f����,� <br />Propased Use o ilding <br />i.zzZ <br />hlall Address <br />Mail Address <br />M17ail Address <br />Square Footaye Qf residential new construclion, remodel or addilion) <br />Number of devices (If low vollage) <br />Description of Work to Be Dane: _ <br />CITY OF EVERETT LOCAI_ SALES TAX CODE IS 3105 <br />C�ty <br />Cily <br />Cdy <br />StalelZip <br />StalelZip <br />Slale/Zip <br />9S� �`d <br />Contract Pricc o( Work <br />Phone <br />Phone <br />�'��f � <br />Phone <br />.�� � n (��22t� 3 SzC/ <br />Comact Person (Plan Review) <br />1 hcre6y cedily that 1 havc read and examined fbis applicafion and know fhe same fo be frue and <br />correcL AlI provisions o/iaws and ordinances goveming this type of �vork will Ge complefed <br />whelher specified herein ornoL The gianling ol a pennif does not presume to 9ive authunty fo <br />violate orcancel the provisions ol any olliersfafe orlocallatv regulating cons(rucfion orUie <br />peAomiance o)constructio Thaf I arn authonzed by flre oirner o(fhis property fo peAorm fhe <br />work /or which applicatio��made and 1 compty �vifh fhe Slate Confraclo�s La�v 18.27 RCW and <br />� - �v�..rlcc <br />Z - r+oro�GprE <br />FEE —I <br />75� l <br />PERMITtf <br />Ei�o�(- [�� <br />