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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 — w.vw.everettwa.org <br />�����, <br />��-;— l �T11 /�v �r/�s�� <br />_r <br />� <br />PRGJECT ADDRESS <br />< C% <br />M1'ail Address <br />Tenant Mail Address <br />�f <br />Contractor MailAddress <br />i� ;� ���� � s�� i n�t a <br />State License Number <br />� F� <br />Proposed Use of Building <br />--, , ; l L� .�-i <br />Square Footage (If residenti I new conslruction, remodel or addition) <br />Number of devices (If low voltage) <br />Descriplion of Work ta Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />StatelZip <br />StatefZip <br />Phone <br />�one <br />�1ZJ <br />City I StatelZip Pl�one <br />����� `�- <br />Contract Price of Work <br />� ��1/L(i <br />Contact Person (Plan Review) <br />I hereby certily thaf I have read and examined this application and know the same to be (rue and <br />conecL All provisions o(laws and ordinances goveming this type o(�aodnti�ill be completed <br />�vhetherspecilied herein ornot Thc granfin9 o/a pemiit does nof presume to give authonry to <br />viola(e orcancel the provisions of any ofherstale orlocallawregulating consWction orthe <br />peifonnance ol cons(ructio 7haf I arn aidhonzed by fhe ownerol this propeRy fo per/orm the <br />work /or which appficah �s made agdLcomply �tiilh the Stafe Contraclors La�v 18.27 RCW and <br />296.200 WAG , = - �� <br />��. <br />� ��j � /��'/,5 <br />Date <br />I i/ <br />I. � _:bEP'v�1'iJ <br />r_��';�,�:�� �_=�i_ <br />FEE y <br />l_-i ���1 <br />PERMIT# <br />EI ;��r �0� <br />