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ELECTRICAL PERMIT APPLICATION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-25i-8810 - FAX425-257•8857—www.everettwa.gov <br />� ���r, ti�' D� . CE , ��-�k <br />PROJECT ADDRESS <br />� � a-is <br />�ISa7--az <br />�,�, r_')l ,,� I O��?r CL-' �F,� k`�i%a�4� <br />� <br />Owner ManAdaress Cdy SlalelZip vnone <br />425-�ssq- <br />c�_ � �� <br />Tenant M,ad AUdress City State/T.lp Pnone <br />Contrar,�of h1aJ Aclaress <br />1tii�ic�v������ F <br />State License Number (requireJ) <br />� QS�c�-e ...r 2 <br />Proposed Use of Bmltling <br />Square Foolage Qf residen�ial new mnsiructi0n, remodcl or addition) <br />� <br />Number o( dewces Qf low vollage) <br />Cily <br />SlaleRip Phone <br />_��n�Cr-�., F3 <br />City of Everell Busmess License Number (required) <br />�q00_ <br />Contract Price ot Work <br />�Jv�� CS p-� Z J,c� <br />�-1]�• ��'l�i � FiLI�, 'p-�C ��� <br />Contacf �ersonlContacl Num6er/Ematl <br />Desviplwn of Work to 8e Done �'� .nh r._..� (` C[ u� �1rQ ��A <,� ��--_ <br />O\ R C�T� a� � L?� �.—\� <br />Y <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br />I he�eby cendy Ihaf I have read and erantined Ihrs app6ca6on and kno:v the sarne 10 Ao truo and <br />r.onocl All prov�srons ollaws and nrd�nances gOvermng flus type ol �vork �vill Ar, complr,fed <br />�vhelher spealieJ hmr.m nr nol The !nanfing ol a pcinvl Joes nnf pmsume lo give aufhonly lo <br />vrolafe w cancel fhe provisions ol any ofher slale o� local law regulahrrg consln�c6on or Ihe <br />peAormance o/ oons6uclion. Tho( I am aulhonzeJ by tbe owner of fh�s properiy fo pedo�m fhe <br />work Por which apphca6on �s made and I r.ompty wdh Ihe Sfale Corrlractors Law I8 27 RCW and <br />296 ?00 WAC <br />Uatc <br />P(l'riC()(���11.^/111 <br />FEE <br />r O � � <br />_J <br />PERMITtJ <br />E(�0�-b12 <br />