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�LECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wv✓w.everettwa.org <br />10 5 21 14 Ty pt,. �-v. <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Mail Atldress <br />Plail Address <br />Cdy <br />Ciry <br />Stale/Zip <br />Slate/Zip <br />6 --��_/S <br />E�5b6 �3t7 <br />Phone <br />Phone <br />l7ih ��unL;.Iw�. j�p.l3ox 2ii� Ly..,.v �98a3C �iz.s-�yz-7�S` <br />Eleclrieal Conlraclor ldali Address City State2ip Phone <br />Dhti ��1; � S�o�Th o'� � 2�1 �� i7 <br />State License Number (required) <br />R 1z Si-� � n.c.� <br />Proposed Use ol �uilding <br />Square Footage Qf residential new consiruction, remodel or adddion) <br />Number o� devicss Q( low vollage) <br />�b�lo�5� <br />City yof Everett Business License Number (required) <br />�'l'S. y o bD <br />Contract Price ot Work ��x4� <br />C�..,y�o.,s1- <br />h L1�.¢ c oK Z �C 743-��,�'L <br />Contact PersonlContacl NumbedEmail <br />Description of Wark to Be Done: � E'�'�' ��`�' �L �� ��+�4.0 L.Y) S��'2 u U u2 <br />1'J u £ T� �'�_r3./�-' <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceAi(y that / have iead and examined this applicafion and know Ihe smne to Ge fnie and <br />correcL All provisions o/ laws and ordinances goveming this lype o/ wo�k will be complefed <br />whether speci�ed herein or noL The granling oI a permit does not presume lo give aulhonty lo <br />violale or cancel fhe provisions of any other sfafe nr local law mgula(ing consWclion or (he <br />pedormance ol cons(nic(ion. That ! am au(honzed by the ownerol this propeRy (o pedonn the <br />work lor which application is made and I comply with the State Contr..etors Law 18.27 RCW and <br />296200 Wi�C. <br />REVISFD 0&9620IJ <br />FEE <br />� �D.pO� <br />PERMIT/t <br />E i5�(� �20�1 <br />