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ELECTRICAL PERMIT APPLICATION <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 /> 5 1 'ir • tinII_ s L)-( 41- Q 'ba03 <br /> PROJECT ADDRESS <br /> tel c. - fir ✓ S. A � <br /> Owner Mall Address .5-• Q 5q • a a co <br /> City State/Zip Phone <br /> Mall Address <br /> Tenant Ma <br /> City State/Zip Phone <br /> Electrical Contractor L. 44 __ p(o Qu 0 6 <br /> Malt Address City <br /> St-ate/Zip Phone <br /> t,14\11.C1 to 1:J �, �}3 p <br /> State License Number(required) ¢ <br /> City of Everett Business License Number(required) <br /> S7 ca- ag3M <br /> Proposed Use of Building <br /> Contract Price of Work <br /> Square Footage(If residential new construction,remodel or addition j m �b a 'g ,p <br /> Contact Person/Contact Number/Email - <br /> Number of devices(if low voltage) <br /> Description of Work to Be Done: I, <br /> 4- . . , - • ♦ . <br /> CITY OF EVERETT LOCAL FEE <br /> SALES TAX CODE 153105 15 o ) <br /> 1 hereby certify that I have read and examined this apprication and knowsame t <br /> to cornea. All provisions of laws and ordlnences governing this type of work will be compl�d and <br /> whether specified herein or not_ The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> pework for which applicationconstruction, <br /> made and/comply with That I am authorized the State Contractorsy the owner of this Law 18 27 RC the E I D h <br /> 1',.200 WA C, <br /> 27RCWand <br /> I `� O I J I O✓ <br /> ��."1-.AIL. `�1 1 I c <br /> Signature <br /> D e <br /> REVISED oa'orveora <br />