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ELECTRICAL PERMIT APPLICATION _ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT WA 9820 <br /> 425-257-8810 - FAX 425-257-8857—www.averettwa.org <br /> 7'a -17A E:!Xa -+r Wim- ?8 201 <br /> PROJECT ADDRESS <br /> Owner Mall Address Cay siate{Lip Phone <br /> Tenant W Mail Address CRY Stat9gI9 Phone <br /> x{25-� -$119 <br /> Electrical Contractor Mall Address City StateOp Phone <br /> State Licensa Number(required) City of Everett Business License Number(required) <br /> Propused Use of Building Contract Price of Work <br /> NATAAIJ WA CI MM LIZS-2_ t8. 17t -} <br /> Square Footage`(if'residential new constriction, remodel or addition) Contact PersonlGontact - <br /> . <br /> Number/Email <br /> reNmbe-- dIces e if low volts <br /> ( g ) <br /> Description of Work to Be Done; <br /> FEE _.. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3108 [ �� <br /> i hereby certlfythat]have read and examined this application and know the same to be true and _ t <br /> correct All provislons of laws and ordinances governing this type of work will be completed ----- <br /> whether-specified herein or not, The granting of a permit does notpresume to give authority to PERMIT# <br /> violate or cancel the provisions of any other�state orlocal law regulating construction or(he <br /> performance or construction. l haft am authorized by the owner of this property to perform the E 1130!5— 0515 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC, <br /> r,w.. <br /> 5-19- 6 <br /> Ignature Gate <br /> REVISED O&W-W f 4' <br />