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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 /> 101 z 3 rnP���;v� A� <br /> PROJECT ADDRESS y2S'Z`�d - <br /> Hqack Qros, �922 B � +-� A�c� �'1u ►�fs�� l� C� �l8Z7o zy29 <br /> Ownet MailAddtess Ciry Slale2ip Phone <br /> Tenant Mail Address Ciry Slale2ip Phone <br /> �Vv I 1v1 <br /> ElectricalCOntfactof MailAddress Ciry SlateJZip Phone <br /> State License Number ConVad Pnce oi vVork <br /> (�P�1 SFR <br /> Proposed Use of Building Contact Person (Pian Review) <br /> Square Footage(If residential newconstruction,remodel or addition) <br /> Number ot devices(If low voltage) <br /> Description of Work to Be Done: �` ✓�� '�`e C �"�� C <br /> FEE � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 l�� <br /> J <br /> I hemby certily fhat 1 have read and examined this applicafion and know fhr,same fo be frue and <br /> cortecf. All pmvisions o/laws and ordinances goveming fhis type ol work will be complefed <br /> whefher specrfied herein ornoL The granfing ol a permd does no�presume to glve authonty fo PERMIT# <br /> violafe or cance(the provisions o/any other sfate or local law regulating canstrucfion or the <br /> peAortnanr,e o/canstniction. That f am aulhonzed by fhe ownerol this propem'to per/orm fhe E I 3 I Z ' D g,� <br /> work lor which applrcation is mad and 1 comply with fhe Stato Conlracfors Law 18.27 RCW and <br /> 296.200 WA <br /> 2 �13� 3 <br /> igna re Date <br /> FEYISED ] <br />