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�5-257-16GG CM H[ATING <br />� <br />02�.IS 14p.m. <br />oi-z3-�ots 3,a <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8870 • FAX 425-257-8857 —�v�:r�� evereltv�a org <br />(�3�� F,�r�;� ' I�c�' Ev 9 8zo3 <br />PROJECT A�DRESS <br />os•,��� <br />Tenant <br />�'(li�c111t1:1 � ilL <br />EI•.clncal Conlraclor <br />f.Wd Addr_;5 <br />t.tai! ACerer, <br />`..� f I�CCrILi�i�L( O <br />bl�il Adda55 <br />('.r)1�1r=7ar��N��"1 }�f�1 <br />State Licensa Mumber (required) <br />proposed Use af puilding <br />iquara Foolage pf residential new conslruction, remodel or additlon) <br />Jumber of devices (If lo�v vottage) <br />)escripGon of 4Vork lo Ba Done � h <br />ITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cd/ <br />City <br />I,' H�� ti Zi� l <br />C�ly <br />St�l?2 p <br />Stdle2�p <br />Stat'2ip <br />1 ��6- i5 <br />Clsol -i�3 <br />�2 �3 <br />Ph:r.^ <br />Fhonc <br />Phon� <br />oll0��`IJ' <br />City of Everetl Business Llcense Number (reyu�redj <br />Z5� � <br />ConGact Pnce ol Nlork <br />I!ZI�I.��l. `i�� L��I �:.:�CC��' <br />Qontact PersonlConlacl Num�edEmail <br />ieieby cerfily fha� I have rr.ad and oxamined (his �pplicafron nnd kno�v fhe samc lo Ge fruo and <br />�rmct. All p�ovisi.ms o/laws and ortlinances go�eming fhis rype olv.oik a�ill be canipleled <br />hefhcrspociluU hemin ornot. The �ran7ir.y o/a pemiit dcos nut presurno (o givo au(honly to <br />ol�te or cancul fhe provisinns ol eny ofher sfate or/ncal I,��v regidafing consfn�cfion orlhe <br />iAortnanco o/wns(rocfion. That 1 am aufharized 6y (bo owner o/(hrs prapeity (o poilomi U�e <br />vF. /or �vbiclt applieafion is made and ! comply wifh fhe S1ate Contr�ctors Law iH.27 RCW and <br />�6 Z00 WAC. <br />r <br />nScD uaoE'oN <br />I �0�3./5 <br />FEE <br />�a.ov <br />PeRr�rru <br />E �5 � ( � �a3 <br />