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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 - wv,rov.everetriva.org <br />S� � �. <br />�11 <br />PROJECT ADDRESS <br />�. <br />�� <br />Owner <br />� 20 <br />Mail Address <br />Cdy <br />c'(�-d� �2(Z <br />�.�� k'�S'�326- <br />Stale2ip Phone <br />Tenant MalAddress Gty State2ip P�one <br />2�-5a5 � 43 <br />���� Pn�il� � �`�-�C�c 2Z3Ci ir�U..c si-� �Ve�T`� �A4`���3 — <br />Electrical Con�ractor Mail Address Cdy StalefZip Phone <br />�'� i ���a?� �67 �7 <br />State license Number (required) <br />S F 2 <br />Proposed Use of Duilding <br />`�C�G <br />Square Footage pf residential new construclion, remodel or addition) <br />Z <br />�, Number o( devices (I( low voltage) <br />� o5��r� <br />City of Everetl Business license Number (required) <br />10 S Sc'� � ��, <br />Contract Price ot Work <br />1 ; A �,5� ��6-545 -�-13 <br />Contacl PersonlContact Num6edEmad <br />Description rf Work �o Be Done: �`� S�\� Ne�.� (7 C.�,� � � rv� C� <br />I�ec 1`v-< e "r1S�' �•n� �^�'�—� <br />CITY OF EVERFTT LOCAL SALES TAX CODE IS 3105 <br />1 hernby certify fhat 1 have read and examined fhis application and know the sarne fo be fnm and <br />corrrcL All provisions ollaws and ortlinances goveming (his fype o( w.odc will be complc(ed <br />whefherspecified hemin on�oL Ti�e granting o(a pcnnd does nof presume lo give aufhonty to <br />violate or cancel the proNsions ol any olhrr state or local la�v regulafing cons(n,aion or fhe <br />pedomiance ol consfruclion. That I am authonzed by the owner of (his pioperty (o pedorm fhe <br />worfc for �vhich applicafion is made mid 1 comply with Ihe Stale Confractors Law 78.27 RCW and <br />296200 WAC. <br />rn��seo cxasoo i a <br />FEE <br />� �D °° <br />PERMIT» <br />E l5�- Ol� <br />