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ELECTI�ICAL <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRFET. EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — �w✓w.everettwa.org <br />PROJECT ADDRESS <br />Owner <br />� / �Q�S�/�� <br />( <br />MP/1"ir1 /MR�9,gCr�ff1 <br />% CO VI C. / 8/d D�i <br />Mail Address <br />/�305 �. S �.1�se Ar.� <br />Tenant � Mail Address <br />�t/� 1�c✓�� �1�� � C- J7d <br />Eleclrical Contraclor Maii Address <br />� /fc�.c ��N1�Q <br />Stale License Number (required) <br />��-��I sale s <br />Proposed Use o( Ruilding <br />�� Qen,o�� j �3�.� <br />Square -ootage (I( residenlial new construclion, remodel or addition) <br />� � g " �- �� ��s <br />Number of devices (I( low voltage) ��`1' <br />Descriplion of W rk to Bc Done: <br />�� I�U�� -t� �%QG <br />CITY CF EVER[TT LOCAL SALES TAX CODE IS 3105 <br />�� <br />Ciry <br />City <br />C�• <br />c�ry <br />,jOC-i <br />S��� <br />,�-� 112 <br />Stale2ip <br />� <br />Phone <br />StaP;IZip P�one <br />/lr.� 9 �n,P�' �03 �- <br />State2ip <br />Phone <br />o s y �oa <br />City of [veretl Business License Number (required) <br />�y, o� <br />CoNrac� Price ot Work <br />��� 96'�59�- 9y/� <br />Conlacl P�rson/Contac�t%� bedEmail ,/,, � <br />J �(CJW%Ll(7'r W�CX CF� /� 9G�� <br />I he�oby cmti/y Ihat I have read and examined thls applicalion and know fhc same fo bc frue and <br />correc!. All p�ovisions ollaws and oNinances goveming fhis type ol worfr will be completed <br />whelher specdied he�ein or no7. The granfing ol a permit does nof p�esume to giv^ aufhonly to <br />violafe or cancel fhe provisions M ony othersfale or local law regulating construction orfhe <br />peAonnance ol constniction. Thaf 1 arn authonzed by the owner of Ihis properfy to perform !he <br />work lo� wh'ch application is made an I comply wilh the Sfate Contractors La�v 18.27 RCW and <br />296.200 AC. y <br />�.'/ � ,S % /i� <br />Revisen ow�;ro i: <br />IS <br />FEE <br />��I�-� <br />PERh1IT,'i <br />E I � 05-DZ'I <br />