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ELECTRIGAL PERIlIIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 n`I c��� (� <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org �5 <br />G1 �loS�—��y <br />zZ �� Sl _ <br />PR/Y,/(��'.N l� ��t / �/7"/)!/.[ � V� ��� N I 7 1 <br />Owner ' Maill+ddress <br />Tenant � FAail Address <br />1�N�� �'�r�c���� � : <br />[leclrical Conlr2clor Mad Ad ress <br />l �iU�(9 ,� � J�i� <br />State License Number (required) <br />1 '�U.J _ <br />Proposed Use of Buildin� <br />Square 4=ootage Q( residenlial new consiruclion, remodel or addition) <br />Nwnber of devices Qf low vollage) <br />� <br />Descriplion of Work lo Be Dc.ie� <br />CITY OF EVERETT LOCAL SALES TAX CUDE IS �105 <br />I hr.rr.by cr.rldy Ihal I have read <br />co�rer,f. /111 provisions ollaws �i <br />whefher spr, ci(eJ hr, rr, in or nol. <br />violnfc ar cancr.l Uir, provi;ions <br />perfonnanr.colconsiruch � <br />work lor whfr.h appllr,ali .� r a <br />296.200 WAC. j <br />rir� w^.o oxvr✓�o ic <br />City <br />City <br />� <br />City <br />Slate2ip <br />StatelZip <br />SIaIE/7_ip <br />�� ��� S�� <br />Phone <br />Phone <br />Phone <br />City of [veretl �usiness License Number (required) <br />�d� <br />Cortract Pricc o( Work <br />Con�act PersoNConta�:t NumbedEmail <br />1,p.xamined �his applir,a(ion and kno�v Ure sanie !o be truc anJ <br />dilinances goveming fhis type ol work �vill be cornpleled <br />gianfing ol a pr.miif does naf prosume fo give aufhnnty tu <br />ny olhr,r slale or local law regulalin9 consNur,tion or �l�e <br />I am au(honzed by the owner ol fhis p�ope�fy (o perlonn the <br />and i compty wifh fhe Sfafe Conhac(ors Law Q.27 RCW and <br />�/�� t <br />Date <br />FEE G <br />��o� <br />P[RMIT1/ <br />E I�Og � ��R <br />