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ELECTRICAL PERMIT APPLICATION <br />28213 <br />PROJECT ADDRESS <br />Owner <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />eot-9 Y - CI y �r - oiv <br />Mail Address City statelzip Phone <br />OPu5 glwlz 7(Fzg �—:r- Wq q�ml yzs-ems <br />Tenant Mail Address city State/Zip Phone <br />A-UE,9 Fi.nt= 5' Sty /0/5- GG Az.4ct N, 9671-r WA ?F03Z 11Zs 9SS <br />Electrical Contractor hail Address City State2lp Phone <br />GG 44=c.!E5V2-2513/3 <br />State License Number (required) <br />Proposed Use of Building <br />Zr7`✓o0rj''F. <br />Square Footage (if residential new construction, remodel or addition) <br />/ I '9CV1 c.r j <br />Number of devices (If low voltage) <br />Description of Work to Be Done. <br />��iti7✓NGi2GG/i2- <br />OZ3Ioa <br />City of Everett Business License Number (required) <br />lS,�oo.e a <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />e'L /Z-f,T Y Aee-6757 <br />L l-ow dOvf1GE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that 1 have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform fho <br />work for which application is made co ply with Poo State Contractors Law 18.27 A and <br />296 200 WAC. <br />Signature Date <br />REVIS009ow"14 <br />FEE G 0 <br />PERMIT# <br />E B 14fl -ofz <br />IZ <br />ra] <br />