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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.everettwa.org �o`�J'"i3 <br /> E 1�jp6-D0�0 <br /> I�� � \niET/�t P� - �.Vc(ZC—TT �{�2D1 <br /> PROJECTADDRESS <br /> �o�Q�A�"� ti1O�i EV U�tA 425�'��41 <br /> Owne� <br /> � MailAddress City State2ip Phone <br /> Tenant Mail Address City Stale�?ip Phone I <br /> Elec�ricdl Con�f�aclor Mail Address City Stale/Zip Phone <br /> Stale License Number Contracl Price of Work <br /> Proposed Use of Buiiding Con�act Person (Plan Review) <br /> Square F`�ge(It residential new construchon, remodel or add�hon) <br /> Nuinber of devices(If low voltage) <br /> Descriplion of Work to !ie Done: �� ���+�� (�"'I A���—/-'�-� i�—" <br />� <br /> I FEE <br /> CITY OF EVERETT LOCAL SAI_ES TAX CODE IS 3105 ���� <br /> I hereby ceriily lhaf I have read and examined this applica(ion and know the same to be hue and <br /> I� conect. All provisions o/laws and ordinances govenring this type ol�vork�vill be completed <br /> � whufhurspecilied hercin crnoL The gran(ing ol a parnit does not presume to give oulhority to PERh1IT# <br /> �� violate or cancel lhe provisions oI a�ry otherstafe orlocal la�v r�egulating consfn�cfion or the r I� O� I Q� <br /> pc�formance olconsUuction. Thaf 1 arn authmized by the owner o/tl�is propwiy to pe�Pomi the C <br /> i:cnk Ior�vhich applicalion is nmde and 1 comply wilh(he Sfafe Con(racfors La�v 18.27 RCW and _ <br /> ?9G.200 WAC. <br /> �J - _ , -� �/�/� <br /> SignaWre ' � ate <br /> Rf_'V�SEO 1)0�13 <br />