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ELECTV <br />CAL PERMIT APP ICATION <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 />0. <br />PROJECT ADDRESS <br />40S i�oML'S ---- <br />Owner Mail Address City StatelZiP Phone <br />Tenant Mail Address City State/Zip Phone <br />SUmMITEL&:v(L\ir bIS3 U15r STIVO Wit') ` sucjrt 3aB S'?S`) <br />Electrical Contractor Mail Address City State/Zio Phone <br /><&ii 000 K-L <br />Slate License Number (required) <br />Proposed Use of Budaing <br />I <br />6a�u <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done _Q I �E NEB DUAL EX <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />05 3 <br />City of Everett Business License Number (required) <br />� 15p�J <br />Contract Price of Work <br />`C`= `12-5 36-h S-;f S <br />Cunlact PersonlContact Number/Email <br />OUER- (Pro S'P_wc,C <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />wheth'=r specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296 200 WAG <br />REVISED CM5W 1i <br />FEE <br />120, �o <br />PERMIT# <br />E I,50S-0-3 <br />