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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 /> L I t4DEA :sirE�1 � v�A~ 58 20 l <br /> PROJECT ADDRESS <br /> Owner Mall Address Chy State(Zlp Phone <br /> Tenant Mali Address city State/Zip Phone <br /> 4Z5-?-*-81 19 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Rprvom&IT SE <br /> Proposed Use of Building Contract Puce of Work <br /> 4Mj1A4'WAC,WM 42-s-218, 17&- 4 <br /> Square Footage(If residential new coh'structlon,remodel or addition) Contact Person/Contact NUM mail <br /> OLA <br /> Number of devices(if low voltage) .rT <br /> Description of Work to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ! 1. Db <br /> ( I hb�Feby certify that'I have read and examined this application and know=the same to be true and <br /> I( correct: All provisions of laws and ordinances govemtng this type of work will be completed <br /> whether specified herein or not. The granting of a permit doss not presume to give authority to PERMIT# <br /> violate orcancel the provisions of any other state orlocal lgw regulating construction or the <br /> performance of construction, chat/am authorized by the owner of thisgroperty to perform the E fVJ• D <br /> work for which application Is made and I comply with the State Contractors Law 18.27 RCW and <br /> 288.200 WAG. <br /> ------__�igna ure t78te �._, <br /> REVISED 0al0a 10N <br />