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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />.�5�� S-..� � �-� <br />PROJECT ADDRESS <br />!'tiF%2/✓/ � <br />Owner <br />Tenant <br />�/� � <br />Electrical Contr or <br />fJaJ AEdmss <br />Man AdGress <br />Mal <br />�7�0� �7����' <br />Sta e Lic=nse Number (requrted) <br />SFR <br />Proposed Use ol �u�lding <br />�s� z >�� <br />>U�x�S ���" <br />Cdy <br />� Square Footage p( residential new conslruction, remodel or addRion) <br />Number o( devices (If low vollage) <br />Description of Work to �e Done: ���� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cdy <br />Gly <br />9 � Z:Z--I � <br />� ,y�/=�aS' <br />yzs 1.�5- <br />State/Z�p <br />S,a,�,��p ��a- <br />S�atelZ�p <br />Phone <br />Phone <br />pfls�� <br />Cdy of Everett Business License Number (requued) <br />Conlracl Pnce oi Work <br />Contact PersonlConlacl NumbedEmad <br />I hereby certily fhaf I have mad and eram�ned fhis applicafion and know the same lo Ge fn�e and <br />con�ecf. i111 prov�sions ollaws and ordinances goveming this type ol work irrll be completed <br />whefhcr specrfied hemin or nol. The granfin9 0l a permit docs not pres nnr. fo give au(honly to <br />vwla(e or cancel the provrsions ol any o(her sfale or local /aw regulahng conshucGon or (he <br />peAonnance ol censfrucfion. That I arn aufhonzed by fhe o�vner o(lhis propwiy (o per/om� fhe <br />worN lor which app6calion is made and I comply wdh the 5(a(e Contractors Law 18.27 RGW and <br />296.200 WAC„ <br />�Z� � <br />PEVr5EO0H96?Ola <br />1=EE <br />�V O� <br />PERh1[T# <br />Ei�-oq- Izs <br />