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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 /> 122 (� Kos s v T H &e 6zie& m <br /> PROJECT ADDRESS <br /> KNIV,% K t,�yere-4 oli9 <br /> Owner Mail Address City T State/Zip Phone <br /> Tenant L Mail Address City State/Zip Phone <br /> G e&riz �� �tax <br /> GlyLhw Q0 LIJ A <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> Ue" %� kl� 00 f 3 0c, . o a <br /> State License Number Co tract Price of Work <br /> L12�&A;ill <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Woo SF <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: 1e`.,aN U e- OA` kVL06 CLOA /L VO 0 j>c <br /> Ci�Gv��S <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 "`7 -60 <br /> l hereby certify that l have read and examined this application and know the same to be true and lI <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 I l C5— v G <br /> work for which application is made and I comply with the State Contractors Law 16.27 RCW and `' 6 <br /> 296.200 WAC. <br /> Signature Date <br />