Laserfiche WebLink
---�-- -- ---, - - - - <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —uvww.everettwa.org <br />�/G /� S . 3,e� �at/L� <br />PROJECT ADDRESS <br />�Y��rr �v.4 <br />g� �a-��{ <br />C ►ko�?-o�3 <br />yLss,9-y• <br />��i� l��cc�' 9zag sz ��E W rv��K��r� ��BZ7s� <br />Otvner LOL�neN O M tlAddress Cdy State2ip Phonc <br />�' �✓erc.f <br />���ia� S. 3za � �E 6v���rr� w� <br />�i 2nant Mail Address City Slale2ip Phone <br />Dw�/�- -- <br />Elecincal Coniraclor Mail Adtlress City Slate2�p Phone <br />State License Number <br />�t� "�i L S/ir/C��� �Ar�'G/ L� <br />Pioposed Usc of Building <br />Square Pootage Q( residenlial new consiruction, remodel or addilion) <br />IJumber of devices pf lov+voltage) <br />Q <br />City of Everetl Business License Number (reqwred) <br />Conlracl Pricc of Work <br />Contact Person/Conlact NumbedEmail <br />Desr,ription ol Work �0 13e f)onc�. I� S� L L- N��% V/L�IJiT _�ji2��AKE� 5 AND <br />130x �a/ niEt.tr La�.�rno.d - <br />CITY OF EVERETT LOCAL SALES TA`! CODE IS 3105 <br />I hr.reby r.ertily (hat 1 havr, rr.aA and exarnmed fhu applicafion and Imow the samc fo be Irue and <br />correcL All provisions o/ laws and oiJinanr.es gnverning this type ol woik vnll he cornplefed <br />whefhr.r spca(ed herrin ur noL Thc grmihnq o/ a penmf docs nuf presume fo yrvc aufho�ity fo <br />v�olafe orcancel fhe prowsior�s nl any ofhr.i stafe or local la�v regula6ng consGudwn or Ihe <br />peAonnance o! cnnslnic0on. Thaf I am aufhanzed by the otwier ol Ihis properiy to P"��onn the <br />work lor w/�ich applicafion is made and I comply �vilh fhe Stale Conlracfors Lmv 18.27 RCW and <br />296 200 WAC. <br />— -- , �if����'R� <br />���alurc// rr�-- <br />vf vi �d� n m�::•.: o �� <br />FEE -- --- <br />�5 06 <br />PFRMI �7! <br />E_��rog_ <br />