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1�, <br />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 />� 5 I 5 � I �t�► �'+ S � � �v� v��+r ��.� A � � �Uc <br />PROJECT ADDRESS <br />,� I�' rv.ilr' _ N-� /� •, c� S� �� � I�'t"�, 1" I I�C'�� <br />�� �• <br />Ownef � Mail Address City State/Zip Phone <br />Silv-�rLake T-�x���� <br />Tenant Mail Address City StatelZip Phone <br />� �I� �I��-t►��� <br />Electrical Contractor <br />� c �� x.� � � � <br />Mail Address <br />C��� 1) E� �- 2'� �� <br />State License Number (required) <br />��} `"� � N Vr <-� G� I �,C' ��;a n I <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />� I `��' �er 1—���— <br />Number of devices (If low voltage) <br />City <br />Description of Work to Be Done: ►^� �" (�"�✓� C, c � I� r L�- �% <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />����� �� <br />City of Everett Business Li nse Number (required) <br />����Sc�� c � <br />Contract Price of Work <br />K���^ ������- �,�� r� �? � SF�� ��C_�h� 'J�y �ic�) ��55 <br />Contact P son/Contact Numbed mail <br />�¢��fi -�I��,. ��NI <br />I hereby certify that I have read and examined this application and know fhe same to be true and <br />correct. All provisions of laws and ordinances goveming this type of woric will be completed <br />whether specified herein or not. The granting of a permit does not presume fo give authority to <br />violate 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 />296.200 WAC. <br />! ��-r-- I ti�� �, <br />Date <br />FEE <br />i I I �� <br />�l <br />PERMIT# <br />El�-lO-l�� <br />47 Z <br />