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ELECTRIGAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERV!CES <br />3200 CEOAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857—www.everettwa.org <br />l�{�D !�t_)�I,���- �'�- ��a°� <br />PROJECTADDRESS <br />Owner <br />Tenant <br />G1ail Address <br />h7ail Atltlress <br />SNz� <br />Electrical Conlractor Rtail Address <br />Cily <br />City <br />l,ar`+�r fd �'ue <br />���� �--�L-� ��D 2 <br />State License Number <br />�('es Cc�ri.�. � <br />Proposed Use ot Building <br />�N� <br />Square Footage (If residential new construction, remodel or addition) <br />Number ot devices (Il lo�v vollage) <br />DescripUon of 4Vork to Be Done: .' " e� `�''" <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />City <br />��,�y / <br />�l3l0 -��� <br />State/Zip <br />Slale�Zip <br />r�8 zn� y� <br />Slate/1ip <br />�,'7U0 <br />Contract Price o( Work <br />Contact Person (Plan Review) <br />I hereby certily Ihaf I have isad and examined Ihis application and know fhe same lo be We and <br />conecf. All piovisions of la�vs and ordinances goveming this type o! �voric �vi11 Ur, compfeled <br />whe7nerspecified heiein ornoG Tho aranting o/a pemiit does not presume to give a«thoiily fo <br />violafe orcancel the provisions ol any olhersta(e orlocal law mgulating consWction or(fro <br />pedonnance ol consWcfion. Thaf ! am authonzed by fhe owner ol fhis pmpeRy fo pedom� Ihe <br />work lor which applicafion is made a id 1 comp/y wilh the State Contracfors La�v 1A17 RCW and <br />296.200 <br />! � /��l � <br />Signalure Dale <br />REVISfOYl6'U <br />Phone <br />Phone <br />Phone <br />FEE <br />—l� °c. <br />PERMIT# <br />E (��4-ltg <br />