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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org � �r 6`15 <br /> ��,�,K� ���„�� � i5oa-05'� <br /> �14t2 • o1Lo <br /> S2o1 Eve���te�ri W�-ti <br /> P,sa� - ��� 7��.��,n , <br /> --� <br /> PROJECT ADDRESS <br /> Owner Mad qddress City SIa1c/Z�p Phone <br /> , � <br /> Tenan( �dad Addmss City Slate2ip Phone <br /> `i�trin�n�� �leci-��c 12�r2 rC. Sv�n�� � pe\l�n��hqm WR �iY�Z2� 3ceo.3S4.98�� <br /> Electrical Contraclor Mail Address Cily Staie2ip Phone <br /> 1 SL-,l-FT1=T�'i�� 4 c. � � ��'S <br /> State License Number(required) Ciry of Everetl usiness License Nur�uer(required) <br /> L�iiroD�ac�1-o/ `� �.�.� COU,.... <br /> Prop�se of Bwlding Contract Price o(Work <br /> L�vl`� Vna ���Cn ��1.40:354•4311 <br /> Square Footage Qf residential new construction, remotlel or addition) Contact PersoNContact NumbedEmail <br /> C�ri'����J��ini����lec�r��c IIC, Co^^ <br /> Number ol devices(If low voltage) <br /> Descripfian of Work to �e Done: �eacua-� /n1�ro�e���r,v�: �� a -1��M2✓ �Jn��C fn-�a c� <br /> (�Cr��oDrn -I- c .ir-r� re - <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 LI �O�� <br /> 7 <br /> I hereby certily(haf I have�ead and examrned Ihis apphcalion and know(he same to be f�ue and <br /> correct. All provislons o/laws and ordinances 9oveminq this type o��vork wJ16e completed <br /> whether speGlied herein or not. The granling oI a permit does not presume fo give aufhonty�o pERMIT# <br /> violate or cancel fhe provisions of any other state or local law reyulabng consfruction or fhe � <br /> pedormance oI cons(iuction. That I am authorized by fhe o�vner o!Ihis property to peAorm the � ��a _OCJ � <br /> work for�vhich application is made and I comply�vifh tho State Confrac(ors Law 18.27 RCW and <br /> 296 200 WAC. <br /> / )� ( ��` oz/ocP/;2o I s <br /> Signature ale <br /> REVI�Eo ofl�'J6?ota <br />