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ELECTRICAL PERMIT APPLICAT10N <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 />-75/1 <br />PROJECT ADDRESS <br />7S// /,jevee:Lj t?lvcf FveptY euri `2'S,ze,? rJs YYf <br />Mad Address r City State/Z-p Phone <br />Tenant Mad Address City State/Zip Phone <br />D-s'•- vecfr• c zej/! U ��11- 9 &S e W TSSS�y> <br />Electrical Contractor Mail Address City State/Zip Phone <br />&S rtG A a6 o u ?L <br />Slate License Number <br />40 <br />Proposed Use of Buildin <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 />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Contract Price of Work <br />Contact Person (Plan Review) <br />/ hereby certify that I have read and examined this application and know the same to be true and <br />correct Atiprovisions or laws and ordinances governing this 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 any other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />-z y <br />FEE <br />.-Zz�� <br />PERMIT# <br />E Iq0'�n)— f0l <br />