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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STR[ET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />�I3c� j�a,h;�� ,4,.,-- <br />PROJECT ADDRESS <br />Owner <br />/�..tLau� <br />hlad Address <br />Address <br />� �ucrC{-Y l..J�- <br />Gty <br />City <br />State/Z�p <br />State/Lp <br />�� �6 yzsk�3 <br />Phone <br />Phone <br />�i� C.J��, �c�rr�� 3o3K Sw c�,wl�a.,� Sfi S�S++G� c..�u�-9X1L6 Zo�93SC/Q� <br />Eledrical Contractor hiaa Address Cily Slale/Zip Phone <br />,4(( �-.�l wE 9 C( c (� <br />Slate License Number <br />�'1 �J �i-1��'1 ! IN <br />Pwposed Use of Buildi g <br />6�t �z <br />Square Footage pf residenhal ne�v construction, remodel or addition) <br />Uumber o( devices (H low vollag�) <br />Descriptian of Work to Be Done <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />� <br />Z c�.o 0 0 <br />CoNract Pricebf Work <br />Contacf Person (Plan Review) <br />1 hereby cerfi(y Ihat I have rec�d and examined Ihis application and know the same to be ln�e and <br />correcL All provisions o/laws and ordinances goveming fhis lype ol wark will be complefed <br />r�helherspeci/ied he�ein ornol. The granting ol a permif does not presume (o give aufhonty (o <br />violate or cancel the provisions o(any other state orfecallaw regulafing consWc(ion or the <br />pedormance ol consfnicfion. That I am aufhorized by fhe oivnero(fhis property lo peAorm 1he <br />work lor �vhich applica(ion is made and 1 comply �vi(h the Sfa(e Confractors Law 18.27 RCW and <br />Rev;sen.v,�a�n <br />fEE <br />155 5 �' <br />PERMiT# <br />E �3io- 0(3 <br />