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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VVA 96201 <br />425-257-8810 - FAX 425-257-8857 —www evereltwa.org <br />�,� � l�) c�l n � �' <br />PROJECTADDRESS <br />Owner <br />Tenanl <br />[lectrical Conlractor <br />License Number <br />11, �1��( <br />Proposed o1 Bullding <br />Mail Address <br />Ma�l Address <br />MaA Address <br />Squaie Poolage Qf residential new conslruclion, remodel or addition) <br />Number of devices Q( low vollayc) <br />Descriplion of WorY. lo De Done: <br />Gty <br />City <br />Gty <br />3 �a�, -► 3 <br />C►3a3-�G� <br />�� SKad� asa-a�<i <br />StatelZip Phone <br />Slale/Zip Phone <br />Slatc2ip <br />Contract Price ol Work <br />Contact Peison (Plan Review) <br />Phone <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hcreby r,ertilylhat 1 have read and exanrined fhis applicafion and kno�v Ihe sarne to be lnie and <br />correcl. �II provisions o/laws and ordinances goveming Ihis type oi �.:o�k will Ue cortiple(eJ <br />whelher speci(ed hcrrirr ornof. Ibe granling o(n pertnd docs not presunm, fo 9ivc aufhanty fo <br />violale orcancM the provisions o/ any olher sfalr. or local faw ieyulafing constnicfion or Ihe <br />prdormance ol consln�ction. ihaf 1 am aulhonzr.d by fhc owncrol (his properfy (o peilorrn Nic <br />�vnrk lor v.�hiclr app6caGon is nmdc and I compty wi(h !hc Slatc Confracfors Law 1827 RC W and <br />296. 200 WAC. <br />�— � � <br />C, _�.i,c./�_,�,c,�z,�_= o v_ 3- a ��!.�__. <br />/Synature - Dtdc <br />l/ / <br />Nr m;Fu 1C��n <br />FEE <br />�� Ua <br />PERMfT�J <br />E 130�-1`1� <br />