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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 — www.everettwa.org <br />i�� yi �� ��7` p� w <br />PROJECT ADDRESS <br />�0��7 i3 <br />e ��/0 '-Ci�7 <br />��n�r� f1al��r� � <br />Owner tvtad Address Gty SlatelZip Phone <br />Tenan� Mail Address City SlatelZip Phone <br />e �i�r ���3 <br />1�,�.�,,� l'11,.�„�� ��/ll9..1� Oc� c�� �,� �,b,.,x;-i� i ��%a��nti �r�l <br />CoMractor �v�ait Add�ess <br />.e� �t�i �� �''� <br />tate Li ense Number <br />Proposed Use o( duilding <br />Square Pootage Ilf residential new construc�ion, remodel or addition) <br />Cily <br />Phone <br />Contract Price (�o� <br />Contact Person (Plan Review) <br />Number o( devices (If low volla9e) <br />Description of Work to �c Done: __��f/�[ .r� �.- b'h� y� ,� � � � � �� %�l <br />--�- - �- - -- -- � �- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heroby ceRi(y that I have �ead and ex:+nrinr.d tlris applica6on and know !he same fo be fn�e and <br />co�rect. All provisions ollaws and ordmances �oveming this type ol work wil/ hr complr,(ed <br />whelher speciGr.d herein or not i�hc grar.(ing o/ a permit does no( presume (o givc auNwiity fo <br />violale or cancel fhe provisions ol any ofhersla(e or local law regulating cons6uclion or Orc <br />perlonnance o/cons(n�clion. That I am aulhorized bylhe o�vnerollhis prope�ty (o perfomi lhe <br />n�or1< lor �vhich anpdcafion is made and I cornply wilh thc S(alc Con(racfors Laiv 1Q.27 RCW and <br />296. 200 WAC. <br />�_i�--.. <br />------ ---------------...— --------------_. <br />S �nature - U.� <br />arwsen�non� <br />F[[ <br />5�°� . <br />P[RMI-�JJ <br />E1310-OC�� <br />