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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 />� `� D Z � �- ����'l E�� �� (d�-�i <br />PROJECT ADDRESS <br />Owner <br />���/ �� �/L � <br />Mail Address <br />City <br />State/Zip <br />Phone <br />��v (�/rc,� (�f�f <br />Tenant Mail Address City State/Zip Phone <br />N'9'iC���L S'i6� �i� l ZSS �rl�¢ll� �W� r/ 5�7� 9��09 <br />Electrical Contractor Mail Address City State/Zip Phone <br />NA�+sco3i�3 <br />State License Number (required) <br />Proposed Use ot Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />City of Everett Business License Number (required) <br />�d � <br />Cont act Price of Work <br />��f�� Z����i� <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: ��j��L ��`Y, ������ �� ,J��! J � <br />�� �2�, i���nu�t. S��n�S <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I 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 <br />violafe or cancel the provisio s of any other sfate or local law regulafing construction or the <br />performance of constru tio That 1 am authorized by the owner of this property to perform the <br />work for which applica ion i made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. / <br />6�o'��/S <br />Signature <br />REVISED 08/06/2074 <br />FEE <br />��� <br />PERMIT# <br />E (50 (�-o z-� <br />