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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEHETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�i-? ►"'l��Qu��-� — <br />PROJECT ADDRESS <br />V`i eJ��� X <br />Ovmer <br />Tenant <br />hlad Ftldiess <br />Mail Address <br />[IeCtriCalCon�ractor MailAdtlress <br />C � �F q�.3 S�c� - <br />State License Number (required) <br />S ��� ��, �� <br />Proposed Use of 6uilding <br />Square Footage Qf residential new conslruction, remodel or addilion) <br />Number of devices Qf low voltage) <br />Description of Work to Be Done: __ `��O _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Ci�y <br />City <br />City <br />SlatelLp <br />State2p <br />State2ip <br />u 'io"l�r <br />��u�r�b6� <br />Phone <br />Phonc <br />Pnone <br />� 0�33�� <br />City ot Everett Business License Number (reGuired) <br />Contracl Price ol Wo�k <br />oP„� S� � �a�a3s-s��d <br />Contad Person/Contact NumberlEmail <br />1 hereby ce�ii(y thaf I have read and examined Ihis applicafion and knoiv lhe same fo be 7rue and <br />conecL Flll provisions o/ laws and ordinances govemmg this type oI work wdl be completed <br />whether speci�ed herein or not. 7he gr��nting o/a permit does nof presume fo give authonty to <br />violate orcancel Ihe provisions oI any ofher slafe or/ocal law reg�dafing consfrucfion or fhe <br />peAomrance ol con ruc�ion. That I am authonzed by fhe ou-nerollhis properiy to peAonn fhe <br />�voik lor �vhiclr appli��tion is,made and I comply wifh Ihe Sta(e Confractors L�w 18.27 RCW and <br />FEVbFO 0�670f i <br />FEE <br />�5�-' <br />PERMIT?t <br />Ei�ll-o�� <br />