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ELECTRICAL PERMIT APPLICATi�JN <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 />� �� 1il) iM(LrinC (�C �JG(� Ui/i' <br />PROJECTADDRESS <br />Owne� <br />pur} <br />Mail Address <br />Pda�lilddress <br />�VISE ��E�T�i� �c. iz�' <br />Elecirical Contraclor tda�l Atldress <br />�NIsF E�E 1�7y'P3 <br />Slate License Number <br />Proposed Use of Building <br />Square Footage (If residentiai new construction, remodel or addilion) <br />Number o( devices Q( la�v voltage) <br />Description of Work lo Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />Crty <br />Cdy <br />Ciry <br />3�ly��y � <br />G-14o3-�65 <br />StalelZlp <br />State�Zip <br />StaM2p <br />� SUv . �°o <br />Contract Price of ��'ork <br />Conlact Person (PWn Rev�ew) <br />1 hereby ceNi(y Ihat 1 have read and examined this application and knov� fhe same (o be tn�e and <br />conecf. All provisions o/ la�vs and ortlinances goveming this type o(�vork �vill be comple(ed <br />c�helherspecified herein ornoL The granting o/a pemiit daes not presume (o give au(honty to <br />violate or cancel fhe provisions of any ofhersfate orlocal la�v regulating consf�ucfion or the <br />peAom�ance ol consfructio Thaf I am aufhorized by the ownerol fhis propeRy lo pedam fhe <br />�vorlc /or �vhich plicati i made ,�nd ! com y with fhe Sfate Confraclors Lmi 19.27 RCW and <br />296.200 WA� <br />�/� _ � / �/Y /� -- <br />ne��isen i �x» <br />Pho ic <br />`1zS339 Gb(, <br />Phone <br />�f2s 7�� 6� � <br />Phone <br />FEE <br />5� 5O <br />PERMiT;+ <br />E1�}o3 -o�S <br />