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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 /> PROJECT ADDRESS <br /> i'iSSitl.f K�'' -j 0t'/LU/ 7 t r i 5 tPt `7 r b'20( <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> `f/pNKS(I GIP .4DDi`TI(y2./ <br /> Proposed Use of Building Contact Person (Plan Review) <br /> 5 > _T 5 21 ) so-GR. a 1 20 5.4 FT- S t o c A6 c, <br /> Square Footage(If residential new construction, remodel o additio. <br /> Number of devices (If low voltage) <br /> ` St) 6iW P _ <br /> Description of Work to Be Done: 5 L{ P/1 CC.' IOC) fAtm P ) 1 C f E / (4 <br /> S a 17 i4 f /1 id a 4 7c"'` / 3 a< <br /> l('f.rj-J. I ./ auL/ /3 66n t c <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 00 <br /> t o9 <br /> 1 <br /> 1 hereby certify that I 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 PERMIT# <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 the E l I O <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and — <br /> 296.200 WAC. <br /> 471-AlitAi G V1/4 OrkjV <br /> Signature Date <br />