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02r''1912e15 aS:40 25�2882156 G�RNER ELECTRI� PAGE 02/03 <br />�.. . s <br />��.�c-r�rcA�. ����n��r,��P�.�c,���on� <br />CITY OF �V'�R��'T PE�t1V��T ��R�IC,�S <br />3200 CEDAR ST�E�T, �V�R�TT, W/1 98?_d1 <br />425-257-8810 - �AX 425-257-8857 � v�uvw_everettwa.org <br />_ � `1 I� ! I ��� �( S� <br />�ROJ�CT ADdRESS —' <br />T�nant <br />�IBctrical Contractor <br />���� <br />State License Num�Qr (required) <br />proposed Use of �uild;ng <br />Mall Addrpcs <br />Mail �ddr2ss <br />� <br />Square Footago (If residentiai new construction, remodel or edditian) <br />Number of devices (IP low voft�ge) <br />Description af Work to Be bone: <br />""r State/zip pllone <br />C�ty <br />City <br />State/Zfp <br />Statc/Zip <br />Phone <br />phone <br />City of �verett I3usinass Liconse Number (required) <br />� � <br />� <br />Contract Price bf Work <br />,r <br />I �� ^ V <br />Coniac# PersonVCont�ct Numuer/�m�il <br />CiTY OF �V�REl'T LOCAI� SAL�S TAX COD� IS 3105 <br />I herehy certify tha# / hava iead and examii�ed this applicaPion and know lhe samca xo be trcre end <br />corr�ct, Al! pr�vrsions of /aws and ordinances governi��g tl�is fype of work wfll ba comp/�(ed <br />whetl�er specifiod hcrein or not. 7'he granfiny of a permr't doQs nat pr�sume to glvo aut�l�o�rty to <br />violate or cancel the provlsions of any otl�er stato or local law rogu/ati�lg consfrucfion or the <br />porfnrmanco of construcfion. Thaf I am aufhorized by fho owner of thls property �e p��orm the <br />wor/�%r wh/ch app/rr,allorr is medc� ,�nd ! cornp/y w/t/� the Sfate Contraciors Law 98,27 RCW and <br />29G.20 WAC. <br />�BI , � , <br />r,�vfsr� earoenn?� <br />FEE <br />�� �� <br />PERM�T� <br />L r <br />� �� �-��� <br />