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/ �� <br />PROJECT ADDR <br />�� <br />Owner <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />�200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa org <br />S� <br />� <br />Idail Add��ess <br />City <br />c►saa-o°q <br />a `a�-� s <br />StalelZip <br />Phone <br />T2n8N IAailAOdress City Stale/Zip Phone <br />�-l� r �S �/<�. 73/ �s� ��_ .f%� 5��.1 �a� �/✓� yb'zyz <br />Electrical Con�racto� hlail Address City State/Zip Phone <br />��,-����3 ��i <br />Slate License Number (required) <br />�PS <br />Proposed Use of Ruildmg <br />�a <br />Square Footage Qf residential new consiruction, remodel or addilion) <br />/ <br />Number of devices (If low voltage) <br />Description ot Work to E3e Dona N�� h•l <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�Js`�SO �" <br />Gt of Everelt 6usiness License Number (required) <br />�/�0. a0 <br />Contrad Price of'A�ork <br />, <br />Contact PerSonlCoNac� NumbedFinail <br />1 hereby certi/y fhal I have read and examined Ihis applicafion and kno�v fhe sarne lo be tn�e and <br />conac(. All prov}� s o//aws and ordinances gaveming this type ol work �vill6e complefed <br />whefher spec) rr d he in ornoC The grnnling ol a permit does no( prssume (o give authonty fo <br />viola(e or caficel the iovisions ol �ny other stafe or loca� law regidating conslruction or fhe <br />performanEe ol cons�n�cfion. That 1 am aufhonzotl by Ihe o�vner ol fhis propeRy fo peAo�m the <br />wodc Ior,G+hich appl(catio��is m� e,an�l compl��Gith (he State Confractors Law 1827 RCW and <br />296.20C(WAC. / � /// � <br />RE'.'SEp 089Y201L <br />FEE <br />-�� Da <br />PERMIT# <br />E (�0 Z- pv9 <br />