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05f16f2016 20:23 <br />#0422 P.00II'001 <br />EL.ECTRICAL P�RlV�IT AP�LICATI�N <br />C1TY OF EV�RETT P��tM1T S�RVICES <br />3200 C�pAR STR��7, EVERETT, WA 98201 <br />425-257-8810 - �AX 425��57-8857 -- www.everettwa.org <br />�'� � q 3 =' ,� �r s�, �Z� <br />PROJECT AQQRESS � �� <br />� r�,�. ��� ���.....�L�;� g 3 `-` � v�e 1� �,�,��� �s�.� �- <br />Owner Mail Address City Statel2ip Phone <br />Tenani <br />Mall Addfess <br />City <br />State/Zip Phone <br />���l�Aar��� .�f.1R iD� l �� �� �� �s� �r� � <br />�lectrical Contractor Map Aatlress City State/Zip Phone <br />C �'�- � �lss � �/x � i� <br />State License Number (required) <br />.�'��2 <br />Praposed Use of $uildEng <br />Square Footage Qf residentlal new construction, remodel or additlonj <br />Number of dsvicos (If fow voltage) <br />Descripticn of Work to Be Done; <br />CITY OF EVERETT LOCAL 5ALES TAX COC)� IS 3105 <br />o �, � 3 � � <br />City of Everett Busin�ss �icense Number (required) <br />�� �� �. <br />Contract Prfce of work <br />Contect Person/Contact Number/Email <br />1 hereby certify that I have read and examined thls applr'cation snd know the same to be t�ue and <br />correct. A!l provisions of laws snd ord/nanoes goveming this type of work will be complated <br />whether speclfled herer'n or not. 1"ha g�anting of a permit does not presume to glve authority to <br />vrolata or cance( the provisions of any ofher st�fe or /ocal !aw regulafing corTstructio� or tha <br />pe�formanoe of construction. That 1 am authorrzed by the owner of fhls property to perform the <br />work lor whrch application is made and I comply wifh the State Co�f��c�o�s �aw 18.27 RCW and <br />296.200 Wf1�`, � <br />S.�/'��/c <br />� �n7i <br />, �: <br />REVlSEO 09n7620iA <br />FEE <br />�^ � p (J <br />( L <br />PERMIT# <br />E � � �'�- �1 �l <br />