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ELECTRI�AL 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 � — l � `� 3
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<br /> PROJECT ADDRESS �5:�
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<br /> Ownef —TMail Address � Q�y StalelZip Phone-
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<br /> Tenant Mail Address Ci�y n��S S�ale2ip Phone
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<br /> Elecirical Contractor Mail Addre5s City StatelZip Phone
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<br /> State License Number Cq,nt�act Price of Work �
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<br /> Proposed Use of Building -� Contact Person (f lan fteview)
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<br /> Square Footage Qf residential new construcGon, remodel or adddion) � �;� , � � ,���,�; �; �
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<br /> Number of devices(If low voltage)
<br /> Descriplion of Work to Be Done: ��l'�V�j-'� f ��l S �'� i � �� ° ���� ��L'� , � ��� ���-r�-�� � � � '� ��
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<br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 G�D•�!�1
<br /> 1 hereby r,ertify that I have read and examined this apP��cation and kno�•�(he sarne fo be tnie and
<br /> conecL All provisions c;laws and ordinances goveming this type of worlc will be completed
<br /> whether specified herein or noL The granfing ol a permit does not presume to give a�dhonty to pERMIT#
<br /> violate or cancel fhe provisions o/any o(her state or iocal law regulating construction or the �
<br /> pedonnance o/construclion. That 1 am aufhorized by the owner o/fhis pmperty to perfomi Ihe E 1 J�; �� ' �'�
<br /> work/or which application is made and!r,omply wifh the State Contracfors Law 78.27 RCW and
<br /> 296.200 WAC.
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<br /> o( . CC'li!P/L!/✓ l.
<br /> �ignature G' Date
<br /> arrsFo.;.c.:.i;
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