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ELECTRICAL PERMIT APPLICATION <br /> C;TY OF EVERETT PERMIT SERVICES L� <br /> 3200 CEDAR STREET, EVERETT, VJA 98201 g ���`I <br /> 425-257-8810 - FAX 425-2:i7-8857 —www.everettwa.org �� //,���� <br /> Y� <br /> .1L2`� SE r- ��«tt MalL—w�— <br /> PROJECT ADDRESS <br /> Owner MailAddress City State/Zip Phone <br /> Qank �� �mCf � CU — <br /> Tenant tdail Address City SlatelZip Phone <br /> C�'25� <br /> Noc �l�wes� Ed,so� 148oy I�llsi QI NE f.)oc��n���lc (�.�� 4ao7z 35�I- U610 <br /> Eleclrical Conlraclor Mail Address City Slate2ip Phone <br /> �Joc'�L� ET qS'� R� 050 ��l � <br /> Stale License Number(required) Ciry of Everett Business License Number(required) <br /> Qo�v� k � I � 500 <br /> Proposed Use of Building Coniract Price of Work <br /> �le Rodn�- �Iz5- 3 5� - o�ID <br /> Square Footage Qf residential new conslruclion, remodel or addition) Contac�PersoNConlact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Oone: � l fD��� NQ`�✓� s i 4 V� �v L�D � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � � � I <br /> � Gj6-�� _� <br /> 1 hereby certily tha(1 have read and examined fhis applicafion and kno�v the same to be We and <br /> conecL All pmwsions o(laws and ordinances govaming fhis type ol wak will be completed <br /> whefher specified herein or noL The granfing o/a pemiit daes nof presume(o give au(hon(y lo pERMIT# <br /> violate u cancel the provisrons ol any other stafe or local law�egulafing conslruction or the � � �0 � _ l�� <br /> per/omiance o(constniction. Thaf 1 am authorized by the o�vner o/fhis p�operty(o pedorm the <br /> work lor which a p ication is made and I compty with the Sfate Contractors Law 18.27 RCW and <br /> 296.200{I�4C <br /> %� <br /> B �o � i� <br /> Sign ie Date <br /> REVISEUoa9Ylola __ __ <br /> 1•1111 <br />