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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257•f3610 - FAX 425-257-8857 - www.everettwa.org <br />2_ w�—t�o �-�- <br />PRO ECTADDRESS <br />J R`(Gl t.� <br />htail Address <br />G�y <br />C��-1 <br />s,�i�iz�P <br />1- �-"T <br />Phone <br />� /��y,✓F <br />Terant htad nddress Clty S�aie/Zp phone <br />f�l�F� Et-c"�?�'-t�- C�C�C. (�3 t�vi if'c�, lr-�F1- �� �Z5 -�`dJ�`�11Q, <br />E.ectrical Coniractor h1a�l Address C�ty Slale2�p Phone <br />{�� t�c����� <br />Stale License Number (requireJ) <br />5� <br />Proposed Use of Building <br />8� �.-Tnm��-- <br />Square Footage Q( residential new conslruclion, remodel or addition) <br />Number of devices (II low vol�agr.) <br />07� � � i <br />Ci1y o( Everetl 8usiness License Number (required) <br />'3� � <br />�Contract Pri[e o( Work <br />�J�'cr, �t"�+— <br />Contact Person/Contact NumbedBna�l <br />�Ii.,� -`F'� � " Sl l2 <br />Descriplian of Work lo Be Done: �^ �"De--L ��<'�.i" � tJP'�'i'p'�iF-1i , �—�""��' <br />CITY OF EVERE7T LOCAL SALES TAX COD[ IS 3105 <br />1 hereby cmtily Ihat I have read and e.ramined (his application and kno�v the same to be tnm and <br />co�recl. All provisions o/ laws and ordinances goveming this fype of r;ork �:ill be complefed <br />whefher specified herein or nof. The grantiny ol a pmmif does nol presume lo give aulhorify (o <br />viola(e or cancellhe provisions o(any ofherstate or'local la�v iegulating cons6vcfion orthe <br />perfomiance of consfn�c(ioa That 1 am authorized by flre o�rnerol this properfy lo peitom� the <br />werk lor �vhich applica(ian is made and I comply �rilh fhe S(afe Contractors La�v 18 27 RCW and <br />296100 WAC. <br />2 /'a-� <br />RENSc009TY.'JI� <br />FEE <br />-�� 00 <br />PERr�ur;i <br />E (�OZ' IOZ <br />