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ELECTRICAL PERMIT APPLICATION <br />CITY OF EV�RETT PERMIT SERVIGES <br />3200 CEDP.ft STREET, EVERETT, WA 98201 <br />425-257-8f110 - FAX 425-257-8857 — www.everettwa.org <br />� 2 sw �i�eF-c-f-� !I1 c�tl I V�a � <br />PROJECT ADDRESS <br />Mt,ll 41..{ev�'G��u� �(,G i`IKz� v.! l.a�.e (xo�Q�nlih 1Z�I S�'u��n�d' WA R8'2`rz <br />Owner Mail Atldress Ci1y State2�p Phone <br />(/ „�J%-a �orf� <br />Tenant MadAddress C�ry StatelLp Phone <br />h ,lf���� <br />Electncal Contractor <br />�=��ZU�Lo�S�3 <br />State License Number (requved) <br />� Proposed Use of Building <br />I <br />� 7 N o� +I-a�e�e So � <br />C�ry <br />Square Footage Q( residential new construction, remodel or addilionj <br />Number o! devices (I( low vollage) <br />Descriplion of Work to Be Done� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />SWte/Zip �.--� P'`non�r <br />�0 � �. � <br />c�Z `( Z 8'(� <br />City of Everetl Business License Number (reqvired) <br />' D��o <br />Contract Price of Work <br />�OV�v�G (JV�'C�C(.� <br />Contact Person/Contacl NumbedEma�l <br />�-1-z� -�-�� - �g 3S' <br />�'h a � el Sr <br />I hereby certi(y fhaf 1 have read and examined this applicafion and know Ihe same fo be (rue and <br />conecL All provisions o� laws and ordinances gov=min9 fhis fype ol work wiU be completed <br />whefher specified herem or noL The gianfing ol a permit does nol presume to give aufhorily lo <br />violafe or cancel fhe provisions o/ any olher s(afe or local law regulaling construcfion or fhe <br />peAormance olconsfrucfion. Thaf I am authorized by fhe owner o/ f(��s properly to perform the <br />work lor which applicalion is made and 1 comply wifh (he Sfafe Conlrecto�s Law 18.27 RCW and <br />296, 20010.41 C. /1 <br />-� / !' `/' <br />rEviSEo f,eR:6'N++ <br />FEE <br />50`� <br />PERMCEN � <br />E f�10 - 015 <br />