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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 l�` ��,,�lF <br /> 425-2`?-8810 - FAX 425-257-6857 —www.everettwa.org <br /> �►'���.i�N <br /> l ��� l f q�`� o.�u�S F_ �r r�� <br /> PROJECT ADDRESS <br /> L9`�n��M <br /> Owner Mail Address Cily State/Zip Phone <br /> Tenant Idaii Address City StalelZip Phone <br /> �53 - <br /> Sl�n� A�,�..� to(�7 c�.,� n,,.�� a.,� c��1 �4W �7 �&z2 <br /> ElectricalCont�actor MailAddress City State/Zip Phone <br /> SM CSaCL 1�1K1 p �5� � ' <br /> State License Number(required) Ciry of Everelt Business License Number(required) <br /> od <br /> � �a6� <br /> Proposed Use of Building Coniract Price o(Work <br /> Square Footage(If residenlial new conslrudion, remodel or addilion) Contacl Person/Contact NumbedEmail <br /> Number of devices(If low v�llage) <br /> Uescription of Work to Be Done: rJ�_—J'h�.X-�l �ih� �_'{�laJ� .QM � �.�C123Y1/� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� �D <br /> I heie6y certify that I have�ead and examined Ihis applicafion and know Ihe same lo be true and <br /> correcL AI!provisions ollaws and ordinanc. ;goveming Ihis fype ol work will be compleled <br /> whetherspeci�ed herein ornol. The granfing o/a permif does nol presume(o give authonfy fo PERMIT# <br /> violafe or cancel the provisions o/any o7her state or local law regulafing consfrucfion or Ihe � / // / � /� � <br /> perlo�nance o/consfruclion. Thaf 1 am aufhonzed by the owner ol(his property to peAo/m fhe ��' / <br /> work lor which applicafion is made and 1 comply with Ihe Sfafe Contraclors Law 18.27 RCW�nd � <br /> 29 200 WAC. <br /> l�.�o.Q� �f " � y'� `� <br /> Signature Dale <br /> i+evrsen aavw�ore <br />