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ELE�TRICAL FERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SER�/ICES <br /> 3200 CEDAR STR�ET, EVERETT, WA 98201 a —I � —� � � <br /> 425-257-8810 - FAX 425-257-8857 —www everettwa.org �I�OZ _-Qq <br /> � �5oa Uic-f�or �(c.ce �ert�-f- �.JJ} 4t;Q'ol <br /> PROJECT ADDRESS <br /> 5h1-AY�t�. 6uQQoWS a5o� �ic�o� PlUce ��eRE�- W�A �3ao� � <br /> Ovmer hlail Aaaress C�ty 51ate2ip Phone I <br /> I <br /> Tenanl tAail AEdress Ciry Slate2ip Phone <br /> ��ul►�� <br /> EleClrical CoNraclor �dall Address C�ty SlatelZip Phone <br /> �i SUo.00 I <br /> State License M1umber Contract Price of Work <br /> 5�� <br /> Proposed Use of 6uilding Con�acl Person (Plan Reviev�l <br /> Square Footage pf residential new construction, remodel or addition) I <br /> I <br /> Number of devices(If low voltage) i <br /> Description ol Work lo Be Done: UP��C'C.�'Y'�Cf,�� (Jp,v�e� I <br /> I — I <br /> i II <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � O O <br /> i <br /> I here6y certily Ihal I have mad and ezamined fhis applica(ion and know fhe same fo bc frue and <br /> cort�ecL All provisions olla�vs and o�dinances goveming fhis type ol�vork�vill be completed <br /> �vhelher speci�ed he/ein or not The granfing o/a permi(does no!prnsome to give aulhonty fo PERMIT�i <br /> violate or cancel Ihe provisions of any other stale or local law regulabng conslrucfion or fne ^ I Lr O� O N � <br /> pedomiance ol conslruc(ion. That I am aufhonzed Gy fhe owner ollhis properf•�lo pe�lomi Ihe t � "� <br /> �vork lor ivhich applicalion is made and I comply H�ifh(he S(ale ConVaclors Law 18.27 RCW arid �' <br /> zd6.200 WAC. <br /> � �� a-i8-aoiy <br /> ignatum Dale <br /> FEViSED 12�YO <br /> 1• 111 <br />