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� <br />� <br />ELECiROCA� P��IVIIT APPLOCA�'ION <br />(:ITY (�F EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA. 98201 <br />425-257-88�0 - FAX425-257-8857–www.eveiettwa.org l:� ��—I � <br />7 <br />�,�a���y� <br />l� `"/v � <br />PROJECTADDRESS <br />V�'Id� L�`� <br />�Vlner <br />Tenant <br />2;ry�1�S� <br />Mail Address <br />MailAddress <br />iL���G��,1���' 30���7� <br />Electrical Contractor MailAddress <br />� ����r�7cD <br />State�cense Number (required) <br />� <br />Proposed Use of Ouilding <br />l�v cS � <br />���Y <br />Square Foolage Qf residential new ronslruction, remodel or addilion) <br />Gty <br />City <br />���� � i � w �- <br />Sta;e/Zip <br />State2ip <br />w ►? <br />SlatelZip <br />G! gZ�2r <br />Phone <br />Phone <br />Phone <br />D�l�s6z� <br />Cily o( Everelt Business License Number (required) <br />__�v � <br />Coniract Price o( Work <br />7A«.. Ll �sq ��' �3 � <br />Conlacl PersonlContacl NumbedEmad <br />� <br />Number o( devices Q( low voltage) <br />Description of Work to �e Done: ( ��[ L/T Y" d r ��� T I"" � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />z <br />! heiehy certily thaf f have read and examined Ihis application and know fhe same lo be frue and <br />cnrrecL All provisions olla�vs and ordinances goveming this type o( work �vill be completed <br />whefher specified herein or noL The granting oI a permit does not presume fo give authonty fo <br />violate or cancel (he provisions oI any ofher stale or local lavi regufating consfruction or lhe <br />peAormance o/construction. Thaf I am aulhonzed by the owner olthis p�operty (o peAoim the <br />work (oi which application is made and I comply with the Sfate Confractors La�r 1827 RGW and <br />296.200 WA C. <br />5 30 � <br />C <br />FEE <br />��D,�° <br />PERMIT# <br />E ��o�-��� <br />