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ELECYl�ICAL PERMIT APPLI��ATION <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 />-� 2 V'� t ve r� ft� �t �.l,tit� �e<<. (c F <br />PROJECTADDRESS <br />Owner <br />VT ��'oazer <br />Tenant <br />L,,KL� �- t-�� ��n � <br />Electrical Contractor <br />��Hc1�'e �42L-�µ$� <br />State License Number <br />Proposed Use oi Building <br />MadAddress <br />Mail Address <br />A1ail Address <br />Ciry <br />�� <br />City <br />N � �2 <br />Ciry <br />Square Foo�age (If residential nev+ conslruclion, remodel or addition) <br />Number o( devices (I( low voltage) <br />Slate/Zip <br />F rv<•c#(,w,� y <br />State/Zip <br />DescriptionofWorktoBeDone: R�ec.tti�n�c� rootf�n fiV�iC k���T <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />SZ C� <br />State/Zip <br />l�.i3 'c <br />Conlrect Price of Work <br />Phone <br />���� <br />j 33 S'OJ� ' <br />Phone <br />�s-}4��i <br />Phone <br />Con�act Person (Plan Review) <br />I hereby certify that 1 have read and examined this application and know the same fo be We and <br />correct. All provisians o/lau�s and o�dinances goveming this type ol �vork u�ill be compleled <br />�vhetherspeci(ed hcrein ornoL The granting o/ a permit does not pmsume to give authonty to <br />violafe orcancel the provisions o(any othersfate orlocal Imv regulating consWcfion or fhe <br />performunce ol cansUucfion. That 1 am authonzed by fhe owner ol fhis property to perfomi fhe <br />�;�ork lor whrch applicafion is mnde and I comply w�ith the State Confractors Law 18.27 RCW and <br />296.200 WAC. <br />� ��,,.c�lc r / `� 3�i3 <br />,:,;c;ss: �a4ai7 <br />FEE <br />(�2' �D <br />PERMIT# <br />E 134D-Dz� <br />