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ELECTRICAL PERNlIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE77, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everethva.org <br />u�u � a� -��� � <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Glectrical Contrector <br />h9ail Address <br />hiail Adtlress <br />Mail Address <br />�`��.b �r Q�la 0�� <br />Slate License jJumber (required) <br />Proposed Use ol Budding <br />��� Square Footage (It residential new construction, remodel or addition) <br />r.i....,1.,,...� .1�„��e� nr ��,,, .,�un�m <br />City <br />Ciry <br />5 <br />�,�Y <br />State!Zip <br />SlalelZip <br />� WV 1 <br />State!Zip <br />Phone <br />Phonc <br />�b l?i <br />Pho�� <br />n ���65 � <br />City of Everett Business License Number (required) <br />� �/V _ <br />Cantract Price oI VVork <br />l�l-4k�,Il,F��S /U� jD3� <br />Conlad Person� cnlact NumbedEmail <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby certily fhaf I have road and exmnined fhis �pplica(ion and knmv the sanre lo Ue fn�e and <br />cormct. All provisions oI(mvs and ordinances goveming fhis fype olv,ork will be comple(ed <br />�vhefhrr specifieA hemin ornoL The granfing of a pemiit does not presurne fo give authonf}� to <br />violafe or cancel fhe Provisions o/any ofher sfafe or local law mgula(ing conslruclion or the <br />pe�fortnance o/constiuction. That I am aulhonzed by the o�vnero! this pivperty fo perfonn the <br />�vork lor �vhich applicalion is made and 1 comply �vith !he S(ate Co�trzrcfo�s Law i3.27 RCW:+nd <br />296200 V✓AC_ <br />,;F,-,«�o����„ <br />FEE <br />}� � D� <br />W � <br />i <br />PERMIT;t <br />E � �b� - O2� <br />