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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.gov <br />�3a� Cvc�c�,��� <br />PROJECT ADDRESS <br />K��i3N�i ��C <br />Owner Mail Address <br />��� �'�� GGKV�u��� <br />Tenant <br />Mail Address <br />City <br />�✓��1> <br />City <br />State/Zip <br />;� <br />State/Zip <br />Phone <br />Phone <br />/�iKI��G SIG�i Ca�t�'�on1 � Z.�S �✓�s�w/�� �✓�. �✓� s�9��c�, 9�8�09 <br />ElectriCal Contractor Mail Address City State/Zip Phone <br />N�iloScaj�m3 <br />State License Number (required) City of rett Business License Number (required) <br />��O' v V <br />Proposed Use of Building Contra Price of Work <br />�I�tt Z,�rr1�nG�N9 <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 />Contact Person/Contact Number/Email <br />Zo� - ZBZ�OlU� <br />�e�e L �,� q���s�� cUr� ��► <br />3 ary, / w�a�t. S���S ��,��/��r Tv P�✓� vE� <br />S�`!✓ c(/L6U�'i5, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify thaf I have read and examined this applicafion and know the same to be true and <br />correct. All provisions of laws and ordinances governing fhis type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of a other state or local law regulating construction or the <br />performance of construction. af m thorized by the owner of this property to perform the <br />work for which application is�d nd comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. �� <br />gnature <br />REVISED 08/O6/2074 <br />l �� D6--1.� <br />uate <br />FEE <br />� � °�- <br />PERMIT# <br />E ��j1 D� ��� <br />