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� <br />� <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FA� "25-257-8857 - www everetlwa.org <br />�l�a� �� /�� � �J ��x�r,u- WA �b"aoy <br />PROJECT ADDRESS <br />��--r3-�3 <br />G 1 a �� -a'7 � <br />3��—c1.�-� Loc��iv�, Cel�sfe, <br />Owner Mail AdOress City StalclZip Phoue <br />Tenanl <br />hlail �tltlress <br />Crty <br />Statc/Zip <br />P�Onc <br />�n."���c�. ���� .�3�O�c �'3S S� �� ���c,Mtc, ���5 �� ��aSa �l�-�5�-� <br />ElectricalConlractor h9ailAddiess Cdy SfalelLp Phone <br />�,�cx�n�- �,s�a���r <br />Slalc l.icense Numbcr <br />Proposed Use of Duilding <br />Square Footage Qf msidential new conslruction, remodel or additinn) <br />L� �-�J — <br />Coniract Price of Work <br />Contacl Pr.rson (Plan Review) <br />Number of devir.es (I( low vollage) <br />Desr.r�plion of Work to �e Done�. �`���_. ��� ������ —_- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />1 hercby r.erh/y fhaf I havc rcad and exarnmed Ih�s appli�ntion anJ know Ihe same to be Gue and <br />cormr.( All provisions o/ laws and orrlinances yovenung Ihis (ype o/ woA< will be complefed <br />whefher specdm.d herem or noL The granhny o! a pernvt docs not presume In givc aufhonty lo <br />viola(e or cancel (he provisrons ol any ofher sta(e orlocallmv rey�dehny consln�chon or the <br />parinrmance ol construcl�on. Thaf I am aulhonzr.d by fhr, otvncr ol thrs pmperN fo pr,r/nrtn (hc <br />�vork /or �vhich opphcatron is rnadc anAl coniply �vdh Ilre 5(atc Conhactors 1 rm✓ ]8.77 RCW ��nd <br />79G 200 lh'AC. <br />� �c��� �� �3 <br />-- ----- -- -- -- - <br />— - ''-- - ----- - -- --- � ua�e <br />� Signature <br />r[ c�sf.n v)rw] <br />rEe <br />�50� <br />fP[RMif1t — <br />LE1311-v73 <br />------ <br />