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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 08201 <br /> 425-257-8810 FAX 425-257-8857_www.everettwa.org <br /> �-r- <br /> PROJECT ADDRESS <br /> Owner Matt Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> his �i 2 o LeC I nro q o��� <br /> Electrical Contractor / Mail Address City Statefzfp Phone <br /> (/7//f} /�A cc �} /� ff 9y�o� <br /> ` �" 5cfA-L� 97Z0 r W <br /> State License(Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price <br /> ,of/Work <br /> VIAJe4 <br /> Square Foo#age(!f residential neW construction, remodel or addi#ion) Contact Person/Contact Number/Email <br /> r'CR S 67C-gC <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: ! <br /> PEE <br /> CITY OF EVERErr LOCAL SALES TAX CODE 13 3105 <br /> I hereby certify that l 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 <br /> work for which application is made and I comply with the State Contractors Law 18.21 ROW and ✓U CJ <br /> 296.200 WAC. <br /> lgnature <br /> Date <br /> a6VISFD OIV e/207c <br /> ie/ze 39dd WWOD/IJiO3-13 3I17DSt/D HW'O:OT STOZ/bZ/90 <br />