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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREI7', WA 98201 6 --B—IS <br /> 425-257-8810 - FAX425-257-8857 —www.everettwa.org C�S�--�j�7 <br /> I� oV I�� �>7 � l,t/I <br /> �� I/,,. <br /> U�-Gt� <br /> �"_I8� �-�,( ,� �t �vcr�f� WQ �J82d ( � R��cf IOGId�+ <br />� ' y � ������ � <br /> PROJECT ADDRESS � <br /> P�McE <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City SIamlZip Phone <br /> �� �[L{{�C f�0 �e�c t�`���- .SPC-F� _ kJ+4 c1 S(0� 2y3G SZo a <br /> EledricalConirac�or MailAddress City State/Lp Phone <br /> �/�C�1 GC�S�Z M V OQ�{`15 <br /> Sta�e L icense Number(required) City o(Fverett Business License Number(required) <br /> �'Zd��.°o <br /> Prcposed Use of Building CoMract Price of Work <br /> .�I�oa( �E(OFNt�4� <br /> Square Footage(If residential new construclion, remodel or addilion) Contact Person/Contac�NumbedEmail <br /> Number of devices(I(low vollage) <br /> DescriplionofWorkloBeDone� �t��[�'�� l�lk �u�+��'�+'1 � ��n'7- �C�1 �^�� <br /> r <br /> l _�C _�a/c_ . SFap Ge i G�sc� C4r��'�,`(���s�{- �n �'x;.� ScKs.�� <br /> ---� <br /> 31p�.�a� l t'�[r _ <br /> FEE <br /> CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerlily thaf I have read and examined Uiis applicalion and know(he same(a br, Irue and ���' � <br /> correcf. All provisions o/laws and o�dinances govemin�fhis type ol woAc will be complefed <br /> whefher specifred hcrein oi noL The granfing ol a pemiil Uoes not presume lo give aulhonty(o pERMCI 1/ <br /> violafe cr cancel fhe provisions o/any other sf�te or local law regulafing cons6uclion or fhe � I�O�� �� i <br /> perlomiance o/consfruc(ion. 7haf I am aufhorized by(he owner ol(his property fo perlonn(he <br /> work lor which applica(ion is made mid I cornply wi7h fhe Sfafe Contnctors Law 18,27 RCW and _ <br /> 296.200 W�C. <br /> SignaWre � Dale � � <br /> Rf.VI5E00(N1G/!ON <br />