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ELECTRICAL PERMIT A�PLICATION <br />CITY OF EVERETT PERM17 SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wv✓w.everett�va org <br />85�� �IUmsac h�l�c�� �����}t, W� ��z�� <br />PROJECTADDRESS <br />Olvner <br />Tenant <br />Electricai Contractor <br />hiail Address <br />1.1ad Address <br />Ata�i Adcress <br />� N �1�iU.t ��SZQ � <br />State License Number <br />5�nn�e �'c�m,l4 rP.scd��e <br />PioposeA Use of 6u .ding <br />Square Poolage (II residenhal new construction, remodel or add�6on) <br />Number of devices (II low vollage) <br />Description ol Work to De Dane <br />—2Q camP_ C��t_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />c <br />;-t,e � c.Fr <br />City <br />C�ry <br />State/Zip <br />StatelLp <br />Stale/Dp <br />� —I�—�� <br />C lyo� `�� 2 <br />1��{25) �Z3- <br />Phone <br />Phcna <br />_ (�fZS -�Z <br />Phone <br />Con •a t Price ot Wor4 <br />N<AtYt(� <br />Ccnlact Person (Plan Review) <br />1 heroby certdy that I have mad and examined thrs appHcalion and Mnow Ihe sanm to be fn�e anJ <br />correcf. All provisions o/ la�vs and ordinances govemmg (h�s type ol �vark wdl be comple(ed <br />whethcr spec+�eA heicrn or nol. The granhng ol a pem�d does not pmsume to give au(honty ta <br />violate or cancel Ihe provisions ol any other stafe or local lau- mgula(ing cons6uchon or fhe <br />perlormance oJ consfruchon. Thaf 1 am aufhonzed by (he o�5•ner ol fhis properiy to perfonn (he <br />werk Ior which app6ca0on is made and 1 comply �vdh fhe Sfa(e Con(racfors Law 18.27 RCW and <br />296 200 WAC. <br />FEE <br />PERMff �t <br />E ( �(o ( - a�z <br />ac rosen �r. a>> � <br />— � <br />