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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 />��10 � SE �Uea�etl r�G !J wai� <br />PROJECT ADDRESS <br />Owne� Mail Address <br />i 2J fJ <br />Tenant Mail Address <br />m lee 8�(bl 1y25 �co���„ < <br />lecfrical Coniractor Mail Address <br />• �w��la-' e�ec�r�`cu� c�o`tn <br />Slale License Number <br />tler:zou �Q�c�.' � <br />Proposed Use o( Building <br />�l l� <br />Square Foo�age (If residential new construcUon, remodel or addilion) <br />Number of devices (I( low voltage) <br />Descriplion o( Work to Be Done: LDf%'1 �Q(`C � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />Ciry <br />Ciry <br />Stale/Zip <br />Slale2ip <br />Phone <br />Phone <br />�2z �rZS-3' <br />State2ip <br />3D. o�o_ov <br />Coniracl Price of Work <br />CoMact Person (Plan Review) <br />� v, �CQ <br />1 hereby certi(y that 1 have read and examined this application and kno�v the same to Ge true and <br />conect. All provisions of la�vs and orclinances goveming Ihis type o(woric will be completed <br />whetherspecified herein ornoL The granling o(a peimit does not presume fo give authonty to <br />vio/ate or cancel lhe provisions ol any othersta(e orlocal law regulafing construc�ion or fhe <br />perfom�ance o/construction. That I am aulhonzed by the ownerof this property fo peiform the <br />�vmk for which application is made and 1 comply tvith the Stale Contractors Law 18.27 RCW and <br />zss.zoo wnc. _ 0 <br />RFVISED 3QOn3 <br />�hone <br />FEE <br />�/�� • � V <br />PERMIT# <br />E ��Dl�- i $�I <br />