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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 org <br />�ISD3�q-S <br />3<03 ld CWSriva j�o/ trT /31V- 40- a') <br />PROJECT ADDRESS <br />Owner <br />Mail Address City <br />State/Zip <br />Phone <br />0 ell <br />Tenant <br />MarAdd,ess City <br />State/Zip <br />�GDhone <br />b <br />� <br />FU � Igor <br />�K(/r, niu0 ; o sr " 1-1 S rAtif i+r u-61` <br />Electrical Contraclof <br />Man Address Cdy <br />State/Zip <br />Phone <br />Sta a �ense Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />a"" 5s G 9 <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />Description of Work to Be Done: '4w <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the some to be true and <br />correct. All provisions of 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 or 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 1 comply with the State Contractors Low 18.27 RCW and <br />296.200 WAC. <br />S'gnature Date <br />FEE <br />g-0 046 <br />PERMrr# <br />E (503- <br />nevrseooMvom+ <br />