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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 />r!a !O 0-QLt, V RV <br />PROJECT ADDRESS <br />RdRYN '� mcmotAs k641 yzs 870-Z-957 <br />Owner Mail Address I City StatelZip Phone <br />Tenant <br />Mail Address <br />City <br />5tatelGp <br />rnone <br />Mc � V <br />erGC Prc- eQ WC <br />ry IL^g8�t' <br />!fzs 50P, <br />0�43— <br />Phone <br />Electrical Contractor <br />Mail Address <br />City <br />State/Zip <br />/gC' - CC) 03"'1 <br />Slate License Number <br />GP.tQ�Co1— <br />Proposed Use of Building <br />Square Footage pf residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Contract Price of Work <br />Contact Person (Plan Review) <br />Description of Work to Be Done: <br />LO //21; Nr" <br />Uc raCri�.P GH2r'+�'C� <br />t- zzA AA101 4j"bEt2&AQt4Aj1) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that 1 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 will be completed <br />whether specified herein or not. The granting of 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 />perfomrance ofconstruction. That I am authorized by the cwner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 16.27 ROW and <br />296.200 WAC. <br />FEE 6 <br />r <br />RMITtk <br />