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ELECT�CAL PERMIT APP�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everetlwa.org s ,..�,�-I 5 <br /> �lS� 5 -ia7 <br /> �Da J-tt w�fi� �a� <br /> PROJECT ADDRESS <br /> Owner Mad Adtlress City StatelZip Phone <br /> UC.C�2ClV� ta�i C�-tt-�7S � �I/ <br /> Tenant MailAdtlress Ciry SlatelLp Phone <br /> f.,m�c��u.K� c, �(�/9 ��G� � T�c� c��4 98r,e$ aSs-5'�i- <br /> lec �calContractor MailAddress City Stale2ip Phone <br /> ' � �,,�o���q3a►-U ���-a33 <br /> Slate Iticense Numbe (required) City ot Everetl Business License Number(required) <br /> L��� S;�e. i3,�rsG , 00 <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage Qt residential new construction, remodel or addition) Contacl PersonlContact NumbedEmail � <br /> pwU�S p�,��5�0� a.�3-88a- d�s 6 <br /> G(cut. <br /> Number of devices(II low vollage) <br /> Description oi Wo;k to Be Done: u�l� �� +'COuI� P.C"7�41nG !l�`SL�UccT <br /> !�p cK��k��nci Ra� �- 7aiD G�-1( 51}c.. <br /> FE[ ll <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 flt' 2(J z . ?js <br /> '�f / <br /> 1 hereby certi/y tbaf 1 havc read and examined fhis applicafion and know thc same fo be Wc and <br /> correct. All provisions o/laws and ordinances goveming Uiis type o/work will be complefed <br /> whether specified herein or noL The gran6ng ol a pertnif does not presume to give aulhonty to PERMIT# <br /> violafe or cancel the provisions ol any ofher sfate or local faw rngulaling conslrucfion or fhe ^ I�h^ _ I^ � <br /> peAo�mance o/conslruc(ion. Thaf I am aufhonzed 6y f6e owner ol this propeAy fo pedonn Ihe C ul� �(j�� <br /> work lor which applica(ion is made and I r.omply wilh fhe Sta(e Confracfors Law 18.27 RCW and <br /> 296 200 WAC. <br /> --�-- �i -�l �D� <br /> Sig alure Dalc <br /> REV15F!)a&Ds901 a <br />