Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br />CI i Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />4 I4 4��, s+ sti✓ <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical Conlractor <br />�nhoUes�{SZQ�i <br />Stale License Num6er (required) <br />��� <br />htail Address <br />�es,�(e�,+,Q t <br />Proposed Use of �uilding <br />Pdall Address <br />Mail Address <br />' City <br />City <br />L �2 ke, 5-fe <br />— ���Y <br />Square Footage Qf residential new consfruction, remodel or addi�ion) <br />Number of devices p( low voltaye) <br />G � so�� �-�'9 <br />9..a9�lS <br />Sta'e/Zip <br />State/Zip <br />Phone <br />Phone <br />Z3q- <br />P�one <br />O-1� �(n� <br />City of Eve ett Business License Number (required) <br />5G0 __ <br />Contract rice cf Work <br />�.las %�IonsO/�?5-Z�a-C�I� <br />Contad FersoniConta t NumbedGmad <br />� <br />Descriplion of Work to 6e Done1 _Z[�,4._�l�raw�.vc� ���te, �" �� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily (haf 1 have read and examined fhis applicafion and know tlre same fo be Lue and <br />co�2 cL All provisions ollarrs and ordinances govcming this type o/ wor� wilf be completed <br />�vhetfrcr speci(ed hmein or noL 7he grarrting o( a pem�i( docs nol presume to givc autliority to <br />violate or cancel the p�ovisions ol any ofher state orloca! Im-i regulating consfniction ur the <br />per(omrance o/ consfniction That 1 am authonzed by the o:vner of lhis property fo per(omr Ihe <br />v�o�k lor wh;ch applicalion is made and! compry �vitlr (he Stale Contracfors Law i8.27 RCW and <br />296.200 WA . � <br />ti ��/� / � y � <br />SignaWre Da� <br />pFWSL00d95rGIJ <br />FEE <br />� D °Q <br />PERh1IT:Y <br />E l ��y�- �o % <br />