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- -- --�-- • - ----- -- - <br /> ELECTRICAL �ERMIT APPLICATION I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — www.everettwa.org �� � �5._�(� <br /> � �y�b-// -Z I <br /> 1�� l j'')c�rrll C�u r Fc.��G�a� L✓c-�fi <br /> PROJECTADDRESS <br /> Owner hlatlAdd�Css City State2ip Pnone <br /> Tenant A1adAddress C�ry Stale2lp phone <br /> � <br /> D�l $(�-� ��ec, <br /> EledricalCoNrac�or MatlAddress Cdy State/bp Phone I <br /> SrrEcs�s�o�a �i3z� <br /> State License Number(required) City ot Everett Business License Number(required) � <br /> M-� ����� I <br /> Proposed Use of Building Contract Price of Work I <br /> Square Footage Qf resideMial new construction, remcdel or addition) Contact PersonlContact NumbedEmad <br /> Number of devices(If Iow vottagel <br /> Descriplion ot Work 10 Be Done� ��" u�� o� q�l�� � �o � C,'�c���'S <br /> td� nc.�J rLGt�✓.��_ 0-ro� , _ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 I � ��(� <br /> 1 here6y certi/y firat I have read and exammed this applica(ion and know fhe same(o be (rue and <br /> correct. All provisions oIla�vs and ordinances goveming fhis fype ol n�ork will6e complefed <br /> v:hetherspecified f;erein ornof. The granting of a permif does not presume�o give aufhonty fo pERh1IT# <br /> violate orcancel fhe provisions of any otherslafe or�ocal lnv regulafing consfrucGon or(he � �� <br /> perfomiance o(constnic(ion Tha!1 am authonzed Uy(he o�vner ol this property to pedomi fRe ��_ (''� <br /> work lor which applica(ion rs made and 1 comply�vith fhe Sfate Contrac(ors Law 18 27 RCW and <br /> 296.200 WAC. <br /> r�I'� �%5� I <br /> Signature Date <br /> � <br /> R�Y�SEO Gfl95.)t: � <br />