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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 —vwvw.everettwa.org <br />3�0� �and P�. s� <br />PROJECT ADDRESS <br />�R� I 5 <br />� � SD/�l�lC� <br />3d'� Y�� 39'� <br />�e-�h '� -lgn��u I� �o`� S�,c� PL g�� �i,,.z�-z,�¢ w`rA 9�3c)3 <br />OwnE� Mad Address C�ry StatelLp Phone <br />p�+,..�.- O c,�,�,�. � �d <br />Tenanl Mail AAdress City StatelZip Phone <br />Has� �� yas-� <br />(�S nl�.��'.�o G.rt-1�..� Flea.�s�_ 3V09 F�c.•+�--F� i9w`� ���'�' �3';�., <br />Electrical Contractor <br />�,�sl�T'GsrJ �a��r� <br />Slale License Number (required) <br />Adtlress <br />�, y.� /e -�ruu, lv Dcu•�!/ � <br />Proposed Use of Building <br />�'��� <br />Square Foo�age Qf residenlial new consiruction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />Description of Work lo Be Done: <br />�'',,,� P'�.�-P <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />State2ip <br />Phone <br />City o( [verett Business License Number (required) <br />Contracl Priceof Work <br />(�a•�,� •�. lQ rcw •1 �/a P� ln / o'�P.� S- <br />Contacl PersoNConl�`m�berl �5 �Q��� <br />� C.p{t� <br />l4lJt.'F �T <br />i hereby certily tha� I have read and examined lhrs application and know fhe same to be troe and <br />correcL All provisions o(laws and orr/inances goveming fhis iype oI work will be complefeU <br />whether speci�ed herein or nof The gran(ing ol a permif does no( piesume �o give authonty fo <br />violate or cancel fhe prov�sions ol any othersfate or local law regulating consfrucfion or (he <br />pedormance oI consfruction. Thal 1 am aulhonzed by fhe owner olthis pmperty fo peAoim Ihe <br />work lor which applicafion is made and I compry wifh fhe Slafe Confracfors Law 18.27 RCW and <br />296.200 WAC. <br />RF. vISED 089620�a <br />FEE <br />✓ O� <br />PERMIT# <br />Ef50I- i'�D <br />