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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PE�f1AIT SERVICES <br />3200 CEDAR STREET, [VERE"1 T, WA 98201 <br />425-257-8810 - FnX 425-257-8857 - www.everettwa.org �_q _ �� <br />z Z r / <br />C � �s-o�j <br />o��r` ? r� s S �%r 2�F <br />PROJECT ADDRESS <br />O�vner <br />/� <br />Tenant <br />��ci I Q I <br />Electrical Contractor <br />Mail Address <br />Mail Address <br />Mail Adtlrcss <br />A1�YAN �P�.q� I n€� <br />State License Numbzr <br />�� <br />/c/*�cQ s �2 v � c -�.� <br />Proposed Use of Building <br />Ciry <br />(� <br />Cily <br />� ,— <br />Ciry <br />Square Foolage (If residential new construction, remodel or adddion) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State2ip <br />1 � <br />Slate2ip <br />StalelZip <br />Contract Price of Work <br />Contact Person (Plan Review) <br />! hem.by certify that I bave read and ex�mined fhis applicafion and kno�+� fhe sanre lo be tnie and <br />correct. All provisions o( laws and ordinances goveming fhis fype ol woik �vill be completed <br />�vhr,lher specified herein o� noL The qranting ol a pemiit does nof prestune ro grve aulhority to <br />violofe or ancel fhe pmvisions ol any ofher sfafe or Iocal Inw regulnting conslrvcfion or Ihe <br />pedomr � e of constmcfion. T��j+n 1 am aufhorized(�y fhe owner ollhis propedy to pedorm Ihe <br />wodc I w iich applicafion 's n�dc and 1 compry dli Ihc Sfate Contractors Law 18.27 RCW mid <br />96. �oA/i ( � � <br />5' � — /'� <br />r-�_wsm az:���3 <br />Phone <br />Phanr <br />Phane <br />FEE <br />'�.�D �� <br />PERMIT# <br />E 1305 - d5 <br />