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Or* • <br />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 />PROJECT ADDRESS <br />Owner V Mail Addrosc 'XIly State/Zip Phone <br />Mi Pl,teblo Gt-oCCiy <br />V er. rnrn Wn.. S .k 203 E m,G i� wit 96_iA�% ��ILC��1�3.4Wd� <br />Tenant Mail A*ddress T City Stale/Zip Phone <br />Electrical <br />Mail Adift" <br />Ncy,.1 c 4- <br />Slate License Number (required) <br />Proposea Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />9 <br />Stole/Zip <br />Phone <br />02 (n2i-1 � <br />City of Everett Business License Number (required) <br />S rit3D <br />Contrail Price of Work <br />�0.4Y1P Sr.,-,r�P.�� 12triv 1(0� 3 ' C7 <br />Co- not Person/Contact Num cr/Email <br />I hereby certlly that I have read and examined this application and know the some to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specdfed heroin or not. The, granting of a permit does not prosumo to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />pedormanco of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the Stare Contractors Low 18.2.7 RC W and <br />296.200 WAC. <br />REWSM 0"WOII <br />9�ic�l <br />19 <br />FEE <br />PERMiT4 <br />EN Dq -09� <br />E0/10 39Vd <br />9NId33NI9N3 3AIl3V <br />096TGLLGZPI BB:ET P107/91/60 <br />