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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 />� �3 � �n- I�l <br />PROJECT ADDRES <br />I ��� ��� <br />p,•,,,e� � Mad ndaress <br />Tettanl f,tal Adtlress <br />;� -i �.c `�i`i �1 1J �x' o �.1 � <br />�/�'�is� <br />[IeclricalConiraetor C:a�,lAdtlress <br />II � � l,��IJ� � ��t�'� <br />iStale License Numbcr (requhed) <br />IProposed Use of �wld�.ng <br />Syuare Footage Qf residen(ia� nevi conslruction, remodel or adddion) <br />�gisaa-o�tz, <br />� -aa-�s <br />�/e��-� � `��3 <br />Cdy StatelZ�p <br />C,ry ryState2/�p�. <br />�t V��Y' <br />City <br />State2�p <br />Pnone <br />Phone <br />pF�� <br />r�-r�,21� <br />C�ly of Everep Business License Number (requiied) <br />CoNrac� Price o� :^/ork <br />Canlact Person Cantacl NumbedEmad <br />Number of tlevices (If low voltage) <br />Description of Work ro Be Done: � Vd ��� �.C� �'�e�-. <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I C �J <br />✓ <br />1 hemby certily thaf 1 have road anA examined fhis apphcation mid know fhe same to 6e t�vo and _ . —. <br />conecL All provisions o(/av:s and ortlinances govemin9 this fype ol �vork u�ill be completed — ------ -� <br />�:�hethcr specdicd herwn or no! Thc rianling ol a penmt does nof presumc fo give au(honfy to PERI•1C�" <br />violate or cancel fhe p�oviswns o7any oUier state orfocall�w regulating consWcl�on or (he �� � � <br />pe�fonnance o/ consfmcfion. Thaf I am aufhorized by the o�vnero( Ihis properfp fo pedorm Ihc � O�� D� <br />�rork lor �vhich applicafion is madc ar�rl l�/pfy vith fhc State Confractors La�v 18 27 RCW and �____ _ <br />296.200 U'AC. . /% � / <br />F[NSfD L° �',5: i!i <br />