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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 />1402 SE Eire re rr tcW way <br />PROJECTADDRESS <br />L)tt:12— SE YY1 <br />Mail Address City <br />State2ip Phone <br />li1�U�Q �,e E2��� I i TPA i G 01 b265 <br />Tenant Mail Address City State2ip Phone <br />\kvtirn I \Ac(en I �I�III"11�Y\Q �O�lo 2�' ,-i SW ti\t.LGnkeT�.t'�'C�CQ� <br />Electrical Contractor Mail Address city State/Zip Phone <br />State License Number <br />Proposed 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 />Contract Price of Work <br />-Te "Iu Lb %V— <br />Contact Person (Plan Review) <br />I hereby certify that 1 have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of work will be completed <br />whether 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 ad comm with the State Contractors Law 18.27 RCW and <br />296.20004c-- " <br />REWSEDIW17 <br />FEE <br />—� cp0 <br />PERMIT# <br />E131Z-133 <br />