Laserfiche WebLink
425-251-7666 CMHEATING <br />7G 1G�.46 a.m. 09-22-2015 3/7 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET7, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — w�rn,v.everettwa.org <br />y I o5 FevcRA�L Av� <br />PROJECTAD�RESS <br />Owner <br />Tenanl <br />Electdcal Cantractor <br />�.1ail Addre:s <br />btail Addmss <br />hlail Atldress <br />Cf111�4MF�g�7 Dr� <br />State Ucensc Num6er (requlred) <br />Proposed Use of 6uilding <br />L V� <br />Cily <br />Crty <br />� <br />City <br />Square Foolagc (If resldeNiai new construclion, remodel or addilion) <br />Numher of devices (If low vollage) <br />7escripllon of Work to Be �one: <br />_�CpNN�CT <br />:ITY OF EVERETT LOCqI. SALES TAJ( CODE IS 3105 <br />l+ <br />Slatc2ip <br />5!ato2lp <br />Slate/71p <br />vncne <br />Phone <br />Phcnc <br />ol(oOqS� <br />City af Everetl Business Lfcense Number (required) <br />�a50 <br />Conlract Price of Work <br />ptBBtQ t�UtRS/yas-as9-�so <br />Contacl Perso lConlacl NumbedEmail <br />�pe$8� � cmt+tRrw �. coM <br />/wroGy coAi/y lhat 1 have rvad and exnminod this application and kno�v fho same (o ba fnm and <br />�orrocL AU provlslans ol lmvs and artfinances yoveming Ihrs typa ol wark wrll he camplotnd <br />�heU�er specifiod hwein ornoL Tho pranfing o/n pemiil daos not pmsmno (o givc auflrority fv <br />�lola(o orcance! fho provislons ofany olhcrsfata orloculla�vroguluting consWc(ion orffro <br />•edannanco ol consbucfion. That I ern ou(horizod by (ho owner o/ fhis property lo pedom� fhe <br />iork Ior which application !s made and I comply �vi(h fhc Sfafo Contrac(ors Law 1827 RCW nnrl <br />'96.200 WqC. <br />?YISEOOSGS:ON <br />Fee <br />JD w <br />PERMIT» <br />E 1�09 —l7`� <br />