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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT S::RVICES <br />425-2570 8CC DARAX 425-257 8857 T www eve�eltwa.org � �`' ��� `� <br />%�l G�/��rr� <br />PROJECT ADDRESS <br />owner <br />Tenant <br />Eler.�rical CoNractor <br />�G�i ���G+/CY% <br />Mail �tltlres. <br />Mail Adtlress <br />� �QI ��c <br />Mail Address <br />�!/�� ��/k <br />State License Number (required) <br />Proposed Usc o( E3uilding <br />Square Foolage (II residential new construction, remodel or addition) <br />NumGer a( devices (II low vollagc) <br />Description of Work to Br. Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />Ciry <br />City <br />City <br />C 14 /0 �oiL <br />l��� ��l�� <br />SlalelZip Phone <br />Statc2ip Phonc <br />,¢ 9ai2 �i'z73 G�l� <br />Slate2ip Phone <br />//TTIW <br />City of Everell �usiness License Number (required) <br />��>�- — <br />Contract Price o( Work <br />Con�act Person/Conlact NumbedEmail <br />I hereby cerfily Iha( I have iead and r.xamined Ihis application und know the smne lo he (ruc and <br />conrcl. All provisions of la�vs and oRlinances govemin9 Ihis fype ol work tvill be conrplefed <br />�vhelfmr speci(ed Rercin ornoL T he c�ranfing ol a pem�it does nof presume to grve aulhonty lo <br />violale or cancellhe provisions oI ary olher sla(e orfocal law re�vlaling consfn�c(ion or Ihe <br />performance o/ conslmcfion. That 1 mn aulhonzed by fhe ownero!(his property (o perfonn (6e <br />�vork /or �vhir.h applicafion is madc nnd I compry �vi(h Ihc Sfale Cunfracfors Law 18.27 RCW and <br />296200 WAC. <br />.L- <br />r•r-vrsrn nrvirv�ui i <br />0� /./� <br />FEE <br />50°° <br />PERMITN <br />Ei��o -v►z <br />