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0 0 <br /> 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 /> �201 � �3'd S4S <br /> PROJECT ADDRESS <br /> -3�n i s <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> hesana4ic' LC P, �a15� ;?oK�► S�' SGJ 5U4"-2v'Jgo36 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> gFs IE-Ecj1- 0o . �� <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> /2 o S� ,4, <br /> Square Foo ge(If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: LV/,5A& dQ. "r5 a 0� 'Ire <br /> ��P� � �a f 00✓� q�P_f'Yf 11G�� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 51) 00 <br /> t hereby certify that/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 l am authorized by the owner of this property to perform the t L <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> f 3a <br /> Signature Date <br />