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I�� ELECTRICAL PERMIT APPLICATION <br />�'� CITY OF EVERETT PERMIT SERVICES <br />�� 3200 CEDAR STREET, EVERETf, WA 98201 <br />; 425-257-8810 - FAX 425-257-8857 — Nnava.everettwa.org <br />;"L��7� `= S,� �v� <br />PROJECT QDDRESS <br />Owner <br />Tenant <br />Eledrical <br />!� �fG)� 5 3��� a ��e' ��✓ <br />� <br />Mail Address City <br />Mail Address City <br />1���,� r-, 4�vi LC� <br />State License Number <br />� posed��e ol Building <br />Mail Adtlress <br />Square Footage p( residenlial new construction, remodel or addition) <br />Number o( devices (If low vollage) <br />Description of Work lo Be Done: <br />v <br />City <br />(,-✓, %I , <br />SIa�elZip <br />State/Zip <br />_„-,. <br />Slale/Zip <br />n <br />PhOnc <br />Phone <br />2 <br />y2h��� <br />�, �oo "-= <br />Coniract Price of Work <br />Contact Person (Plan Review) <br />2GG <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODi IS 9105 7� � <br />! <br />I he�eGy ceriily (hat 1 have read and examined this applicafion and know the same to be fnie and <br />correcL All provisions o/ laws and ordmances goveming fhis type ol �vork will bo complefed <br />whe(her specified heroin or noL The granting ol a pennit Aoes not presimie fo give aufhority fo PERDIITS <br />violate orcancel !he pruvisions ol any ofhersfate orlocal faw re�ulafing consfruction or tlte ��� n �{ � ���/ <br />pe�fonnanc� ol cPnslrucfion. Thaf 1 am aufhorized by fhe o�vner olthis property fo perlonn fhe t,� "�"' (� <br />wori< (or w4iith &pplication is made�nd 1 camply n-ilh Ihe Sfate Confractors Law 78.27 RCW and <br />29s.zoo'wAG." / � <br />-Z �l- Zv � 3 <br />