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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 �2 _3, -+4 <br /> �I�iiz -i� 3 <br /> 3S �8' Mo�'� ,��1� <br /> PROJECT ADDRESS ��� _ <br /> �v, n-,r /�-h�On el_�,S 3S?$� Np,t�v-�- q,✓e �Jc%;r G,J4 9�Zi� i 3l0 -96 �R" <br /> Owner MailAdCress C�ty Slate/Zip Phone <br /> Tenanl MailAddress City SlatelZip Phone <br /> .�6 � - <br /> l,l� esa� ��ec�i2.l�. 1�i77 -r17�S` Jl�l= /t'7+4c�f,J/�tc l,�• 9PZ�r� co�� �zo� <br /> EleclticalConlraclot MailAddress C�ry Slate2ip Phone <br /> (a? -� riP.� 93�K� �S 3 yC�/ <br /> __�' Cit o(Everetl Business License Number(required) <br /> State License Number(required) Y <br /> ��n� — <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage pf residentiai new construclion, remodel or addilion) Contact Person/Contact NumbedEmail <br /> Number of devices(I(low voltage) <br /> Description o(Work to Be Done: t� /V'G� P�a Si�i 1 �'I G��l -G--✓a^ti rl <br /> F[E <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��OD <br /> I hereby ce�tily(haf 1 have read and examined Ihis applicafion and know Ihe same fo 6e Irue and � <br /> correct. All provisions o/laws and ordinances goveming fhis fype o/wo�k will be completed <br /> whethcrspecified herein or noL The gran(ing o/a pertr�it docs nof pmsume fo give authonty fo PERMIT# <br /> violafe or cancel the provisions ol any othersfate orlocallaw regulafing consf�ucfion or fhe � � , I� � J � � � <br /> peAormance of construction. Thaf I am authonzed by fhe owner o/Ihis property to pedorm the `r <br /> work lor which application is made and I comply with fhe State Contracfors La�v 18.27 RCW and <br /> 296.200 WAC. <br /> ���l/��l <br /> Signature Dale ' <br /> BEV15ED oao6?o Ia <br />