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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.evereltwa.org <br />PROJECT ADDRESS <br />ITS _ 31a.1 I Is-. s� v< <br />Owner Mail Address City <br />�1$0(4_01a <br />y _3-4-5 <br />rei'i vll� onw W)3-, <br />Staterl,p Phore <br />om h&%+S a(,Do W Pd E_ v_ refF W 9V0'i 525 Vqf? 0 <br />Tenant �-. �,rr,s Ctv Slate2D Phore <br />'_II E(tckr:(- Corpora+;oh <br />E o, tr, ,al Contractor "- I Address <br />5C*0Y5B1 <br />State License Number (required) <br />MgfAv 'te,4..r:til,4 <br />Proposed Use of Building <br />Square Footage (It residential new construction, remodel or addition) <br />Number of devices (II low voltage) <br />Description of Work to Be Done Pro r cle- <br />Ql�m s. <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br />kltsal�:r�;lie WA 48a1 o5yP51 <br />City SlatelZip Phone <br />o31-o S <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />►I 0ec}r:L 4 as <br />Contact Person/Contact Number/Email <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work Wit be completed <br />whether specified harem or not The granting of a permit does not presume to give euthonty, to <br />violate or cancel the provisions of any other state or focal law regulating construction or the <br />performance of construction That I 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 />REVISEDO&O& , <br />FEE <br />4 102.�.� <br />Er <br />`D4- D(0 <br />