Laserfiche WebLink
ELECTRICAL PERMIT APPLICATIaN <br />CITY OF EVERETT PERMIT SERVI� ES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - v,�ww evereltwa org � � r f� <br />J-/ <br />� IUD�-OS� <br />�lol�i �uc i�er A�Q <br />PROJECT ADDRESS <br />�Q r� � �Ipr <br />Ownef t.iad AGdress <br />0 <br />Tenanl <br />� •� '✓ ,:Z.� Z L <br />[lecirical Conlrador <br />!,1ad AGdiess <br />�U��� >�Z <br />1.1ai1 AdCress <br />��ve`Ec�`1�Zc� <br />State License Number <br />2as�devi � �c. � <br />Proposed Use ol �udding <br />Square Foolage (I( residen�ial new conslruclwn, iemodel or adddion) <br />Numbr.r of devices (If low voltage) <br />Ciiy <br />j-Iz5-359- y�7S <br />Slate.2�0 Phcne <br />Giy SIaIeIZ�p Phone <br />i.{zS5.�3 �-l3os <br />5� LV 4v�G� WR /QJ z�� __ <br />C�ty StatdZ�p Phone <br />3� `� <br />Contract Price of VJork <br />Ccntad Person (Pian Review) <br />UcscriplionalWorkto�eDonc.. _ �nU✓1�I�I�Qloe+2��de Sv�SFPW1 l.��idl��-� <br />FE[ <br />CItY OF EVERETT LOCAL SALES TAX CODE IS 9105 I�O�� <br />I Ireieby cerldy Ihat I have read and aeamined fhis applicafron and know fhe sarne lo Ge Inie and _ <br />earrecl. All provisions ollaws and ordinances gnveming Ihis type ol wo�k �vill be camplefed <br />whefhcrspecificd he�ein or noL Ihe gianling ol a pennd does nof presume fo givc aulhon(y (n pERt•717;t <br />violafe or cancN (he provisions ol any olher sla(e or local law m.gulaling conslruction or Ihe E � 4�3 � � <br />peAomrance ol consfruc(ion. Tf�at 1 am aulhonzed 6y Ihe o�vner oRhis properfy fo pe�lonn Ihe <br />work (or �vh�ch apphca�ion is made and I comply K•i!h fhe Sfafe Contraclois Law 18.27 RCW and __ <br />296 200 WAC. <br />Yvl c�,��� � 2 z o r_— <br />Signature � Date <br />FL 1+yf D J`i11 l <br />