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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 /> I�c �- OR���� -��. Ev�rc�-1 l�Jc�., ct8Zo1 <br /> PROJECT ADDRESS �\�J-��`O�` `� <br /> `R;��nc.�-a���or--c�v� �Z� 10.5��\��J i, n��wo�c�. u�-g����� <br /> Owner Mad Adtlress Cily StateZp Phonn <br /> ���^�' <br /> Tenani Mail Address Gry Slate2ip Phone <br /> -�-�-�1.. ���1{J� <br /> Elec�nWlConir3C�or Ma��lACdre55 Gly Slate�Lp Phona <br /> State License Number(requued) City of Everett Business License Number(required) <br /> Sl �'1C.,rA � �l.M� �� �C�._)� � YlC <br /> Proposed U e ol BuAding � Contract Pnce ol Work <br /> ISQuare Foolage�resi�al�onstraclion, remodel or addlUon) Contact PersoNContact NumberlEmail <br /> I � <br /> Numher ol devices(It low vollage) <br /> Descnption ol Work to Be Don�. r L.1�� \1� C�.7\ �L -��� OC�T��\-� <br /> FFE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �7�o O <br /> ! / <br /> I hom.Ay ceRAy fhat I havr, read and exarnmed fhrs appl¢aGon arrd know fhe same fo bo tn�e an0 � <br /> co�ecf. All provisions ollaws and nrdinances govermng thrs fype ol work wJl Ge compleled <br /> whefhcr specdied herein or nnL Tho grdnling ol a pennd does not presume to grve aufhonty fo PEAMIT# <br /> v�oWfe or cancel the provisions ol any ofher sfala or local law�equlafmg construc6on nr fhe � <br /> peAomiance of cons Wction. That I am authonzed Dy the owner o/fhis propeRy lo Oe�lorm the ���7 -� O� <br /> work lor which app6cation is made and 1 comply wdh fho Sfato Contractors Law 75.27 RCW and v <br /> 296.200 WAC. <br /> C�V)�, '�, �V� �,A �� � c�'�' � � <br /> —~ignaWre Date <br /> W[1'6COGfti.fi^.01� <br />