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lOr'15/2014 00:38 <br />#5593 P.001/001 <br />E�ECTR�CAL P�R1'VliT APPL�CA�'ION <br />ClTY OF �VE ETT PERMfT SERV'IGES <br />32D0 C�pAR TREET, EV�RETT, WA 88201 <br />A25-257-8810 - F �25-257-8857 — vuww.Ev�rettwa.org <br />� �, <br />PROJECT ADpR�SS <br />Owner <br />��S s' c�r�� <br />Tenant <br />r <br />Electrical Contractor <br />���'/ y2 <br />StatE License Number (required) <br />� ^- <br />Mail Addrgss <br />� ��s ��� � <br />tutaii A�dress <br />s `„ <br />Mail Add ss <br />Square Footag� (If residential new construction, remoqel <br />Number of devices (If low voltage) <br />Descripiion of Work t0 Sa Done: <br />GITY OF �VERETT LOCAL SAL�S TAX CODE IS 3705 <br />I hereby certify that ! have resd and examined this applic� <br />correct. AU pravisions of laws and ordlnances gavern]ng i <br />whefher specified her$in or nof. The granfing of a pe�mif <br />violat@ or cance/ the provisrons of any othar state o� local <br />Perfo�mance of canstruclion_ That / am authorized by the <br />work for whicn licafian is made and I comp/y with the : <br />296.200 WA�� <br />City State/Zip Phone <br />�, y�s �s��2 <br />City <br />c;ry <br />State2ip <br />�� <br />State/Zip <br />�� Phone <br />� �-l� J <br />Phone. <br />d�� � <br />City of Everett Eiusiness Licettse Number (required) <br />S � � <br />Cont�act Price of Work <br />Contact Person/Cont3ct NumbeNEmai! <br />� <br />FEE <br />�� �_ <br />� and know ths same to 6e tru� end <br />iype of work Wlll b� corqp/�ted <br />s not pr�sume ta give authorlfy to PEFtMIT# <br />regulating �pnstructi� or the <br />�e� of thls property ta partorm the E � J, - O� <br />9 Contr�GtOrs LaW 9$.27 RL'W and U <br />