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ELECTRICAL PERMI�' APPLICATlON <br />CITY OF EVEREl'T P�RM[T SERVIGES <br />3200 CEDAR STR�ET, �VERETT, WA 9820i <br />425-257-8810 - FAX 425-257-8857 — vwvw.everettwa.org <br />���� �����-����� � <br />�� <br />pEtOJECT ADDR�SS <br />s� ��� <br />�r .� l �' /� �` 13 %'��'� ��t ./ �� v !Zt � �S'�t-� <br />Owner <br />ienant <br />Electrical Contractor <br />Meil AddrBss <br />Maii Address <br />�_.��-,� �G <br />Mail Address <br />� �V <br />Sfate License Number (requfred) <br />�' ��' � �� R.-�'� cu S'�� <br />Proposed Use of 6uilding <br />Square Footage (If residential new construction, remotlel or addition) <br />Number o€ deviCes (If lowvOltage) <br />Description of Work tv ge Dane: <br />CI7Y OF EV�FiETT LOCAL S74LES TAX CObE IS 3105 <br />City <br />Clty <br />City <br />'�J <br />StstelZip <br />State/Zip <br />Phona <br />I�hpne <br />Phone <br />_ , O/ �-(�� 1 <br />City of Evetett BUsiness icerise Number (required) <br />/� �I�f' �3/ ZZ �' <br />Contract pnce of Wark <br />� <br />�GaG�� � <br />Contact Person/Contact Nurnber/�mail <br />f hereby ce�tify that I have r8ad end examined this appifcafiorr and know the sa�nB to be Err,re and <br />correct. A!1 provisions of laws and oMinances govemfng thls type of work wfJl be complefed <br />whether specifred herein or not. 1'he granting of a permit does not presUme to give authority to <br />violate or cencel the pmvisfons of a»y ather steie or focaf law regulsting construction or the <br />perform&nce oF constn�ction. Thet ! am authorizeQ by th� owner of thls prope�ty to perform th� <br />work fdr whrch� plfcation is msde and ► comply wFth the State Cont�ctors Law 18.27 RCW and <br />2ss_z6o warA,� <br />oeaxnova <br />��� <br />��� � ��� <br />P�RMIT# <br />E'��-��� <br />I <br />1001100�d OOEZ# LZ LO SIOZ/�L160 <br />