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ELECTRICAL PERMIT APPLICATIOM <br /> C17Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> I <br /> � <br /> I <br /> .�--, D`� (�'�.h�1) �.t�� <br /> I� PROJECT ADDRESS <br /> II ''"'�w� �n� - - CA State/Lp Phone <br /> O�vner Mail Address Y <br /> Tenant <br /> I�lailAddmss City State2ip Phone <br /> ��� 1 r ((�� .}/"iD \��{����� }'Vl/£ N� �")I\✓A/V{^w ��7 IV ���7�U/ 2c�y����il <br /> Electrical Contractor <br /> MaJ Address Cdy Stateldp Phone <br /> Qmr��,�Gq�2 � �� 2�,`� <br /> Conlract Price of Work <br /> State License Number <br /> P�osed Use of Building Conlact Person (Plan Review) II <br /> I <br /> I <br /> i Square Foolage pf residential new construction,remodel or addition) <br /> I' Number of devices Qi low vollage) <br /> � �� �A►�.��,�y�t�' �"U 2u�+A �� 4 <br /> Descriplion of Work to 8e Done: ��3� ��� � <br /> �t,�- U�U -- <br /> � <br /> FEE I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��U� <br /> 1 heml;y ceitify that 1 have read and examined this applicafion and knowlhe sarne to be(rue and <br /> correcL All provisioi�s o(laws and ordinances goverring fhis type o/�a�oric�vill be completed <br /> I whether specilicd herein ornoL The,qranfing o/a pe.mit does nof presume fo give authority to PE.RMIT# <br /> violate or cancel fhe provisions o/any other state or local la�r regulafing constn�Gion or the � I ��� � _b � �I <br /> pedormance ol construciion. That 1 am authonzed by the owner ol this property to per/orm the <br /> work for which application is made and!comply wilh fhe Sfafe Confractors Law 18.27 RCW and <br /> � 296.200 WAC. <br /> tl i�l�� � <br /> S�aWr � -- D te ,i <br />