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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 <br />c���� w<<(o�,� �o <br />PROJECT ADDRESS <br />I —1 �1- f,$ <br />E�sp�--Ob� <br />Jti-w-�Y �(t �fiiNC,c-x� lo� a7 (ti; (fo w y RcQ bu.�,.�t" �^'U+- q�'3o3 �-dG -3� -�'S1s <br />Owner Mad Address Gly SlalelZ�p Pnone <br />Tenant <br />Mail Adtlress <br />Cily <br />Slale/Lo Phone <br />�� w�orti �`Z�c��r � oo�f l�'v�` /i�z Nc REbwtUvy� w�- �j�0-t "' �I�.TddSa7d�9 <br />Electrical ConVactor htau Adaress C!y Siate2�p Pnone <br />L� �vD � Ea y a G� Gv1 �j <br />Stale License Number (reqwred) <br />Proposetl Use of Building <br />Square Footage Qf residen6al new cons�mction, remodel ar addilion) <br />Number of devlces (II low vollage) <br />�escnption of Work to Oe DanF: ��(i LiH=LN/T <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City of L-verett Business License Numbcr (required) <br />�� , � <br />Contract Pnce ol Work <br />✓�IK�L� ����— Y� I= d'64- Y�i7v <br />Contact PersonlContact NumbedEmail <br />I hereby cert�ly fhal I have read and exammed Ihis applicafion and know fhe same lo be frue no <br />correcf. All provisions o/ /aws and ordiwnces goverrrirrg this type ol work wili be complefed <br />whether specdied herein or noL The granhng o! a permd does not presume to grve authority fo <br />violafe or cancel the provis�ons of any olher sfale or local law regulating ronstmction or Ihe <br />peAormance o/ consfrucfion. ihaf 1 am authonzed by fhe own?r ollhis property to peAomr the <br />work lor which aoplicafion is made and � comply wrth Ihe Sfafe Confracfors Law 78.27 RCW and <br />796.200 WAC. <br />J/ �i VYr-� � /� l /l � <br />FFVISED o&ON2ola <br />FEE <br />� �oo <br />PERM[T# <br />E I 501- D�� <br />