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I <br /> 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 /> �2 -r7"�� <br /> C �y iz-Iz L <br /> ;�� lS ���PS fi�Je, <br /> PROJECTADDRESS <br /> Ownef MadAddress C�ry StalM2ip Phone <br /> Tenant Mail tiddress Ciry State2ip Phone <br /> � l� ���e C'T�P� -f�✓�� ,S9U/,.7ZG'ySrsJ l�f l T l,�JCZ 98�f 3 �D6 9/'� 7Sc�5 <br /> Electr�oarjCtor MaJ Address Ciry Stale2ip Phone <br /> ��elen •tio88 (� C� ZS032 <br /> State License Number(required) City of Everett Business License Number(requiied) <br /> �e 5 . �. 0 0 �. m c7 <br /> Proposed Use of Building CoNract Price o' .Vork <br /> /C/�C�1QPI( lJ /�'ff �E'L' �2COWGruT.�.oT <br /> Square Footage Qf residential new construction, remodel or addilion) Conlact Person ontact NumbedEmail <br /> Number of devices (If low vollagc) <br /> 7 ��O u.� Z � .n C c� <br /> Description o(Work to Oe Oone: �Q_-� �)�����4"�e 1 �- ` ' '-�'�{' <br /> '�l.l' � SP �l,�Tz_� -�2o�..ti 1� c:� � YF�Du�� To COl-� <br /> � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 � j� <br /> { <br /> 1 hereby certily thuf 1 have read and exammed fhis applicafion and know fhe same to be(rue and <br /> correcL All provisions o/laws and ordinances goveming fhis type ol work will be completed <br /> whelherspecified herein or not. The 9nnling o/a permif does not prrsume fo givc aufhonty to PERMIT# <br /> violafe or cancel lhe provisions o/any ofherstate orfor,al law reyulating construcfivn or fhe � � �I � " I�� <br /> peAonnance o/construcfion. Thaf 1 am aulhonzed by tbe owner o/fhis property(o perfonn(he <br /> wo�lc(or which applicafion is rnade anAl comply with fhe Stale Conlractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � �_ f Z - � 7^ /'-� <br /> Signature Date <br /> REVrSED 0596?01I <br />