Laserfiche WebLink
� <br />� <br />LECTRICAL PE��IIi �PPfL�CAT��� <br />ci�� �� �v���T� P���o����voc�� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — vwvw.everettwa.org <br />� . � <br />_ <br />�-`��� � � L-a, ���--�Vt�t� �����. �,ic%.� � <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />1 � <br />� Y «-� � > <br />Elect ical Contractor <br />Mail Address <br />Mail Address <br />�-�--t" � /{ �,_ -i � � <br />�� <br />Mail Address <br />��� `'`F�'li� �� I-`�� �'�1 �� <br />State License Number <br />Proposed Use of Building <br />City <br />City <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />State/Zip <br />L[-c K—=�- �-c�/✓-1/? �� C�c,f:� <br />Phone <br />Phone <br />State/Zip� >CC�I � 2'7..� c� � � <br />J <br />/�' � �-� J , <br />Contract Price of Worl< <br />Contact Person (Plan Review) <br />�� ��-� ��_ <br />I hereby certify that l have read and examined this applicafion and know fhe same to be frue and <br />correct All provisions of laws and ordinances goveming ihis type of work will be completed <br />whether specified he�ein or not. The granting of a permit does not presume to give authority to <br />violaie or cancel the provisions of any other state orlocal law regulating construction or ihe <br />performance of construction. That I am authonzed by the owner of this property fo perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296. 200 WA � - � <br />�i � <br />; I /� <br />' . ._ _ -�- - -=--�� � � � / / _ 1. <br />Signature Date <br />FEE <br />��0� <br />PERMIT# <br />�Vv 1 � V� (,Ju <br />