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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everethva.org <br /> �{�a� �a1��+�� /��_ <br /> PROJECT ADDRESS <br /> ����„�a„� �1�06 ��A� ;,���ft �/�- q� <br /> Owner P h7atl�tltlress City StatelZip Phone I <br /> Tenant h"ad ACdress Ciry Slate/Zip Pnone <br /> ; �..��,�1�� P�16 ''�13�a �3� iq�°�r-,s� c.v�� ��036 <br /> I Electrical Conl clor Mail Address Cdy State2ip �onS-,,. <br /> I �y' <br /> �ba <br /> �.fhCKS C9a4�� �� I �(c�o <br /> Stale License Number(required) City of Evetett Business License Number(reqwred) <br /> � ��QO� <br /> Propo,ed Use a Building Con�ract Price of Work <br /> r�,,,,� ��f �-�s�'/95 <br /> Square Footage(I(residential new conslruclion, remodel or addilion) Contacl PersonlConlact NumbedEmail <br /> � Number of devices Qf Iow vollageJ <br /> I� 1r6Ra,�1 h�uJ a��� �� Gir�r, 4�� � <br /> �I Descr p�ion ot Work lo(3e Done: <br /> I ��.V C�./�V� �S <br /> i <br /> I � <br /> FEE <br /> CITY OF EVERF.TT LOCAL SALES TAX CODE I5 3105 � �S,W.� <br /> I hereUy cerL(y fhaf I havc read and exarnined this app/icafion anA kno�v the sarne fo Ge fnfe and <br /> conecf All provisions o/laws and ordinances goveming Ihis(ype oI�voik will be complefed <br /> �vhelherspeci�eA herein ornoL The granting ol a pennit does not pmsume fo 9ive aulhonty to PERMITOt <br /> violafe or cancN fhe p�ovisions o/any ofher stale or loca!law regulafing consfruction or fl�e r � �O�l O�^ <br /> peAormance o/constniction. Thaf 1 am authonzed by fhe ownero/lhis properiy(o perfonn the C L <br /> work!cr u�hich applicalion is made and I comply wifh Ihe State Confracfors Law 7827 RCW and <br /> 296.20 WAC. <br /> �/ _I `1�-1.L-- <br /> Signa ure Date <br /> RF1'6eDGST5001< _____ _____.—.----- --- <br />