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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERNiIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />?°I�,�I�P� �IJ <br />PROJECT ADDRESS <br />Owner •�! /�ac �-}-�-{�, 7a�l�y�qr�ress <br />(P lJ J I"� I I V Y I <br />Tenant <br />btal Aa_ress <br />M11alAddress <br />C N E I�C-r I�� S� 1 Iz ,l <br />State License Number <br />( O 1✓t4� P I�l'n G� I <br />Proposed Use of Bwlding � <br />Square Foolage Qf residential new construclion, remodel or adddion) <br />Number ol devices (If low voltage) <br />Descnption o1 Work lo Be Done: <br />�� <br />��II�-z,� C� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Gry <br />vei <br />C�y <br />� <br />a- ��� � <br />�� �o a—D��� <br />Slale2i0 Phonc I <br />��� 1�-�.5 �� <br />—�I o <br />ate/Lp Pnone <br />�A �gox� ��s-�w-3s1 <br />Slate2lD Phonc <br />���i�� c1� _ c�0 <br />Contract Pnce of Work <br />Ke✓� �Ca�� <br />Contacl Person (Plan Revlew) <br />� �� <br />1 hereby certi(y fhaf I have mad and examined fhis application and know Ihe same (o be true and <br />conecf. All provisions o/ laws and ordinances c�oveming this type ol work will be complefed <br />whethcr specified hemin o� noL The granfing o/ a pennif docs nof presume fo give aufhonty fo <br />violate or cancel fhe provisions ol any ofher stafe or local law mgulafing construction or (he <br />pedormance. o/ construction. Thal 1 am authonzed by the owner o! this property lo perlorm the <br />work for which applicalion is made and I comply wilh fhe Slafe Confraclors Law 78.27 RCW and <br />296200 WAC. <br />� <br />�+ewseo.vsa�u <br />FEE <br />��J�� <br />PERMIT# <br />E���Z��y�S <br />