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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />s200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8870 - FAX 425-257-8857 - vnvw.everettwa.org <br />PROJECT ADDRESS <br />� _y-IS <br />_a1l <br />� �50� <br />�j� ► ; � Jv1 � e, -twe+n-k-t� �-1� �� (1 C,e u.� �- �vere�-4 `� �2v ( <br />Ov:ner �:,ad nna�ess Gy Staie�bp Phone <br />� L7�XY�-� UZ� - � -�11 l� �-1 � 1 ��`"�'� - � 7 ( �'� <br />�. Tenant t.1ad ntl^ress Cily S191e/7ip Pnone � <br />Elecirical <br />tLad l.dCress <br />_{�S tiTf,SN� 3a1Q-� <br />�� Siate License Number (reqwred} <br />� S � ��fi � <br />Proposetl Use of E3wld�ng <br />Square Footage (If res�aenhal new construchon, remodel or addition) <br />Numbe� of devices (II low volta9e) <br />Uescr�phon of Work to Be Oone <br />:�i <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />C�ry <br />$IatC�Zip <br />PhOnC <br />(1 ��lCo� 5� <br />G�ry of Everett Busmess License Number (required) <br />� ��—� - <br />Cortract Pnce of Work <br />Dau� g� d��9Sl���f � <br />Coniact Person/Contact NumberlEmail <br />1 hereby certdy fhat I havo read and examrned this applrca6on and I�now fhe same !o be true and <br />conec! All p�ovisions ollaws and ordmances govemmq fhis rype olwork wdl be cornp/eted <br />whefhr.r spec�fied hereirr nr nof. The gianlmg ol a pcimil does no! presume fo grve authonty lo <br />wolafe or cancel !he p�ovisions o/ any olher sfale or local la�v iegulahnp conshucLon or the <br />peAomiance of consfiuchon Thal I am aulhonzed by fhe oa�ner ol fhis property fo peAorm fhe <br />u�nrk (or whith applicahon is m�de and f contpty �srlh Ihc Stalc Confracfors La�v 18 77 RCN'antl <br />296 200 WAC, <br />. . c, sr o ,:R^y. t,+ <br />FEE <br />50 °° <br />PERMITx <br />E►502.0�1 <br />