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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIGES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />��7 � t � � k � � �..- �.�. � �a.a ' � � � � <br />PROJECT ADDRESS <br />�a��;�.�lo�. �i�.vClUn�m¢.�4- (oB�kU �ir-4- �ent w�t Sc�,�� - )_�.A �t� (uY ��'C� ��33 -�3� <br />Owner Mail Ac1dress City State2ip Phpne <br />Tenant <br />C� � � �4-a--c--i-t`'' <br />Electricai Contracfor <br />et.c' C�3Ul <br />Mail Address <br />Mail <br />�C' Ut�s ��/�.S �=1 �t,3 Q��- <br />State License Number (reyuired) <br />( �7�ln�t,�rc�c.ti. � <br />Proposed Use of Building <br />G Sh. <br />Square Footage (If resldential new construction remodel or addition} <br />Number of devices (If low voitage) <br />Description of Work to Be Done: <br />CI7Y �3F EVERETT LOCAL SALES TAX CODE IS 3105 <br />Gity <br />City <br />StatelZip <br />State/Zip <br />Phone <br />- ✓ �� - l a t-tt� <br />Phone <br />��'`� t C.� �.�. <br />City of Everett Business License Number (required) <br />� �� �� <br />Contract Price of Work <br />��S�;n (�.tt+-.bti� <br />a�"3-�`�,2�(�tvs' �.5,�4�n,� v� �,e�c�f-s��, <br />Contact PersoNContact Nu �eNEmail <br />I hereby certifv that 1 have reacl anci ezamrned this a�plir.atic�n and knoev the same io be true ancl <br />correct. A1! provisians of laws anci ordinances goveming thrs type of work wiN Ue cornpleted <br />wi�ether specificd hereA� or not The grar�i�ng ot a penniP cloes not presume to qive authority to <br />violafe or cancel the prowsions of any other state or loca! law regu�atN�g construcCron �r ti�e <br />performance of constructicm That 1 ai7� aufhorized Uy the owner of this property fo perform the <br />wprk for which 8�plication is rnade and 1 corttply with the Stafe Contractors Law 98 27 RGW and <br />296 200 WAC. <br />�Fvrsr-r osio�zci� <br />a3��s <br />FEE <br />S�Ou <br />PERMIT# <br />E��S���-I ��� <br />I+- <br />