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ELECTRICAL PERMIT APPLICATION <br /> �ITY OF EVERETT PERMIT SEaVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> /9�a /��va alwa� <br /> PROJECT ADDRESS <br /> Owner Ma�lAEdress C�ty � State2ip P�one <br /> L�l �i�e��o�i��� 3roa �Ibu ��� ��� �,��t ��aa/ <br /> Tenanl MadAOEress Gry State/Z,0 P�one <br /> NQr„�ec emmum�twts,fiit DOBo� 1IS�LY1��✓ ��n GUl9- 9�P,�?�` <br /> Eleclriw�Contrac;or MaAAddress Gry State2�p Pnone <br /> IVEGt)TE('_L ISln �La �3303(� <br /> State Ucense Number(requlred� City ol Everett Business License Number(required) <br /> �,��'� — — - �i oo. no <br /> Proposed Use of Buildmg Conlracl Price of Work <br /> �9 $�l� Tim �a�a5 (9�5')347• 7lco� <br /> Spuare Foota3e(If resi0ential new constmcdon,remodel or addition) Conlact PerSonlConlacl NumDLer/Email <br /> 10 S�M F�0.faS (d r7PwT[tjt[chvYl. [O.i-t <br /> Number of dealces Qf low voltage) <br /> p _.a�� ��O/ C�/�•7 C �/�//� �✓.(t.� <br /> Descn tion ot Work to Be Done <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 ��.D D <br /> 1 he/eby certity fbat I have resd and examirted this applicotion and know fho some fo be frue and <br /> conecf. All provisions ollaws and ordinances goveming IRis type ol work will be compleled <br /> whefher specified herein or noL Tho granling ol a permR does nof presume(o give authonty fo PERMCf# <br /> violate or cancel the provisions of any other stefe or local law mgulafing consfmction or the 1 <br /> performanco o/const�vclion. fial 1 am oulhonzed by fhe ownor ol fhis propeRy fo pedorm the E I �f D g � ( �� <br /> work lor� � 6 applicafion Is mada end I comply wifli the Stale Confraclors(a�v f827 RCW and <br /> 296.200 C. <br /> � -Zl- Zoi� <br /> igna�ure Da1e <br /> RCV�SED06ONIOR <br />