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� <br />� <br />EL�CTRIGAL PERIVIfT APPLICATION <br />CiTI( O� E1/E�ETT PERMIT SERVICES <br />3200 CEDAR STREET, EVER�TT, WA 98201 <br />425-257�881Q - FAX 425-257-8857 -- www.everettwa.org <br />i ��- � O g S �> �. 4^� /�� �� L.'�-T Q'g o% � <br />PROJECT ADDRESS <br />� ovr 1�a--�' a— � 1 S flr-� ��D� Ll � 5• 3�3 •(o3�`�t <br />Owner Maii AddrEss City SlatelZip Phone <br />Tenant <br />�n��i naa�Ess <br />city <br />stateirp <br />Phone <br />���m�a-�-�. l-kA.-� r.q y � 01 3 � 3� ►� L s�� I� �o�- q�, �s a o� ��I 8� o <br />�12CtriCal ContraCtor M81I ACICjfP.$5 City Slat9lZip Phone <br />�_�y�� �� � <br />State License Number (required) <br />J� � <br />Proposed Use of Buifding <br />Square Footage (If residential new r,on5t�uclfon, remodel or addition} <br />Number of devi�es (Ef low voltage) <br />Description of Work to Be Done: ��, a��. `�.,I <br />CITY DF EV�F��TT �OCAL SALES TAX COD� 1S 3105 <br />oa a� 3 � <br />City of Everett Business License Number (required) <br />��� <br />Contrac! Price of work <br />�a:� mr � � CS�o • a� 8.�t � o <br />Contact PersonlCont�ct Number/Email <br />I h�reby r,eKify that r heve read and oxamine4 thls applieati0rl &nd know the ssme to be true and <br />correc�, All provis;ons oflaws and ordinances governrng th;s type of work wil� be completed <br />whether specified herQrn or not, The granffng of a permit does nat presurrre tv give authority to <br />violate or cancef the pravisrnns ot any o�her state or loca! law regulating c�nstruction or the <br />petfo�m&nce of constructian. Thdt ! am puthorized by fhe owner of tf�is proper1y !o perform th8 <br />work for which applrcafron is m2de and I Comply with thc 5t�16 Confracfors Law id.27 RCW and <br />'1�9�, 200 WAC. <br />51a� I I s <br />aKv�,SFn o9rocn.oia <br />( .v <br />FEE <br />� � C,� <br />PERMIT# <br />E �50 5 ._ � �( <br />