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ELECTRICAL PERMIT APPLICATION <br />CfTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT. WA 98201 <br />425-257-8810 - FAX 425-257-8857 - N�ww.everettwa org <br />s1a,C� � <� c�h c� t\, � lAJ L l� e� � <br />PROJECT ADDRESS <br />�lyos�33 <br />S-6��y <br />���1 �mA-� 3�c�� So2�i�,�� � L-_�ere� �P� ��3 <br />Owner n�aunaa�ess Gty �tale2p Phone <br />`t"�,S - 353- y3 � <br />Tenant <br />Mail Atltlre55 <br />Cny <br />SIa:e2ip <br />PhOnc <br />C t \ S� � � \�J�—� <br />Electncal Comractor AtaJ Adtlress Cily SlatelZip Phorc <br />Stale l�cense Number <br />�s-� �\�e,✓\� � <br />Proposed Use of E3uild�ng <br />Footage (I( residenl�ai new canstrur.tiun rernodel or adddion) <br />Number c( devices �il iow voitagel <br />Descnplion ol Woik to Be Done <br />l\� <br />Contraa Price o( Work <br />Contaq Person �Plan Revizvq <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! he�eby certdy fhat ! have read and exarnined tltis app6C�'lbOn a�lA hnOtvlbe Saq�P lo he tme 8nA <br />couecf. AI! p�ovisrons o/ laws and orti�nances yovemmy tlus type ol work wilf Ae compleled <br />whe(her specilied hr, �ein o� nol The granting o/ a Pennif does not preswne fo �ive authonty !o <br />violafe or cantel (he pmvisiais ol. vy o(her stafe orlocrl law ie9ulahng consfnulion nr the <br />peAonnance o/constniction. Thaf I am aufhonzed by lhe or:ner o/:hrs property fo pedonn Ihe <br />wo�k lo� wlrich appbca(ion is maAe ard I comply �w(h Ilre Sfafe Con(racfors Law 78 27 RCW and <br />PF.l9cCUY16'3 <br />FEF <br />rn o0 <br />;J �-� <br />PERMITx <br />E � y-c�5-�33 <br />