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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 />�3d1 �(�-�'` �U'2 w ����� ���� <br />PROJECT ADDRESS <br />t-��71n.� C�-Q� VV`��` C�� <br />Owner Mail Address City State/Zip Phone <br />�-lDl � � �03 0( 3��'`- A-v c-- � �lrc,re;14- w�4 °1�Zo 3 <br />Tenant Mail Address City State/Zip Phone <br />Ol�eh �1�e�.�r,c 1v�.. 32S w�,,�ti;,,�roa. 11�5-�tl�,�v.�-- �,rt�- ��03Z 2S�-8iz-r�us <br />Electrical Contractor Mail Address � City State/Zip Phone <br />�c�S� N �� �3 � �c <br />State License Number (required) <br />��mvv�.Vcl�4 � �' !r <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (If low voltage) <br />C��l.co l oZ <br />City of Everett Business License Number (required) <br />€� � ��� .��.� <br />Contract Price of Work <br />�e r�Y l�ura S kc k c,� �,.. �- <br />Z�� �',?"Z l°tc�S 5���7 ►� olSeh�cLe(;. <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: I NS � l�-�(, �(IZ� �{�.%Z-/l.� VP 70 CU /� � <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 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 <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.?�0 WAC. ,_ <br />/ , <br />���� � D��b 8/ �61� <br />REVISED 0 8/0 620 1 4 <br />FEE <br />�. "1 Z. `�� <br />PERMIT# <br />E ; ��-n�� <br />�G- 11,1/� <br />