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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 />i-]Z S ' E�E��a�J �,./Av <br />PROJECTADDRE55 <br />Qcfa�*iLY �E.17£-�Zf 53�� SW Vn£A�v� f LAkL l�iV�GE1D O�L /�V7� ��Di�If�3'T%�D <br />Owner MailAddiess Ciry SWIeIZip Phone <br />7enant <br />nln�na�lcsr , <br />Elecirical Conlractor <br />94� S u <br />Mail Address <br />�t �/.� S• <br />Mail Address <br />n�o�F� g7sYY�S <br />Slate License Number (required) <br />4�-a� � <br />Froposed Use o( Building <br />��� <br />Square Footage (If residentiai new consiructiun, remodel or addilion) <br />�� <br />Number of d�vices pf low voltage) <br />�E � <br />aty <br />City <br />�—■ <br />State/Zip <br />Wn Yv3z <br />Slate2ip <br />Phane <br />��fl`�y <br />City of Everett Business License Number (required) <br />�G,7�o.00 <br />Contract Price of Work <br />q��a �,-��- ��20�) Z`%t-ZT'�z <br />Contact Person/Conlac� NumberlEmail <br />Descriplion of Work to Be Done: �} f10� T1 e� > F Fr �zE f}LPizh,, DE�� c� FUQ p¢v�G� <br />tOVEQPLtC %�c.o¢�ir�Ci TD �Gi�/� 7l Fv2 �Eh� iL�n�/1rIT ,�Ul�•pvr. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily Ihat I have read and examined fhis applica�ion and know fhe same to be (nre and <br />correcL All piovisions o//aws and ordinances goveming this fype ol work will be completed <br />whefher specified herein or noL The gran(ing ol a penni( does nof presume to give au(honty (o <br />violate or cancel fhe provisions o/any ofher 5fate or/o:allaw regula(ing cons(n�cfion or fire <br />pedormance ol consfruclion. That I am aufhonzed by ihe ownerof Ihis propehy fo pedorm the <br />work /or which application is made and 1 comply wi(h the Sfale Confractas Law 18.27 RCW and <br />296200 WAC. <br />C:�J� -', <br />REVISE�OP/05?OfJ <br />rylR l�'� <br />F[E <br />��� �� <br />PERMIT# <br />E !�f(a-D�( <br />