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L__J <br />� <br />ELECTR�CAL, P�R��IT AP�'L�CAT�ON <br />CITY OF EVE�ETT PI��MIT SERVICES <br />3200 CEDAR STREET, �VERETT, WA 98201 <br />425-257�8810 - F/aX 425-257-�8857 — wuv►rr.ever�ttwa.gov <br />i / ' wl� ■ Ii' . � � . � � ''�� r , <br />�. ..- <br />�� �,��� � .�� <br />Owner Mail Aetlres <br />��,� Cl���c �Z7 �,�'� <br />7enant Mail Atldras� <br />� . i n . r. �. _� � . 1 !.. _. ,..r-�' _ 1 iLL� l ✓�� <br />ctrical Contraotor <br />C�I,�,r�� � �3 �'S' <br />State Llcens� Number (requfred} <br />���! Gt�� <br />Proposed Use of Bullding <br />Addr'�6s <br />Squaro Footage (If resfdentia n��Cons#ruction, remodel or acldition) <br />�� <br />Number of devices (If low voitage) <br />Descrip4lon o� Work to Be Done: <br />CE7Y dF �V�RETT LOCAL SALES TAX COD� IS 3105 <br />Gity <br />City <br />City <br />�Sa�L as���,���2_ <br />State/�ip Phone <br />�sJz�s9_ <br />���� <br />Stato/Zfp Pnone <br />'8/3S� �--� <br />State/Xip Phone <br />o�� �3 <br />City of Everett Business License Number (roquired) <br />��. � <br />-� <br />Contract Price ofVvork �� �� <br />������/�� ' ��2 <br />Contact erson/ ntact umber/Email <br />�vr-�-i l C i � <br />1 hereby certify fhef 1 hsve �ed end examined thrs application and kn��w the same to be truo and <br />correct. A!I provisions oflaws and ordinsnces gaveming this typo of uvork wi!l be Comp/eted <br />whefher speaified herein or not. The granting of a permlt does not pre►sumQ to give authorlty fo <br />violefe or canc9l the provision$ of any oiher st8fe or locel !aw r�gulating construction or the <br />perfnrrnance of construction. That / am authorized by fhe owner of thJs properfy to p�rform ihe <br />work for wh/ch eppllcation is made and l comply with the State Contractors Law 18,27 RCW and <br />O(7F Ol�A IA/dr` <br />R�vrSED OdNG2016 <br />FEE <br />�` I`���'� <br />PERMZT# <br />E�i��g%�� � <br />