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� ELE T I � <br /> C R CAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857—www.everettwa.org <br /> l�` U l'i1"v�wcc/ <br /> PROJECTADDRESS <br /> S-���_ c.�ro��s l3/0 �ro�l� ��,-��tf wi1-�P�s2al <br /> Owner Mail Address � City State2ip 2!'7 /�Phone <br /> .7 Gl 7G/7 <br /> �[7 <br /> Tenant MailAdtlress City Slate/Zip Phone � <br /> ����S ���r,c 7�� ZS�'�fI S� /I/L'� .-��wh t,,,�� �f ��/� i <br /> Eleclrical Contractor Mail Address Ciry State2ip j�2 Cr Phone � <br /> �JC�.Jd g 7���"2 I <br /> �Lr4���F.�4�3�1�q � <br /> State License Number(required) � City of Everett Business License Number(required) <br /> t f(�vd <br /> Proposed Use of Building Conlracl Price oi Work <br /> �olev�i C�eY� yZS=J6o—�"�3'�?- � <br /> Square Footage pf residential new construction, remodel or addition) Contacl Person/Contact NumbedEmail I <br /> Number of devices(I(low vollage) <br /> Descnption a(Work lo Be Done: ��l01�� � <br /> FEE <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 �o OO <br /> I hereby certi(y lhaf I have�ead and examined this application and know Ihe same to 6e�rue and <br /> cormc(. All provisions olla�vs and ordinances goveming this type ol wo�N will be completed <br /> whether speci�ed herein or noL The gran;ng of a pemiif does nof presume fo give aufhonty fo PERMIT?t <br /> violafe or cancel the provisions ol any others(ate orlocalla�v regulafin,q consWcfion orfhe � �� I �J I t , � <br /> pedomiance oI cansWc(ion. That 1 am authonzed by the o�vnero/this property to peAorm the �� <br /> �vork Ior which applicafion is made and 1 comply�vi(h fhe Sfate Contractors Law 1827 RCW and <br /> 296.200 WAC. <br /> ����Gr l2zz �y <br /> � e'Signature Date <br /> RFV!SEOOd9Yl0ii � <br />