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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRLLT, EVE RETI, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />rfsfo-�6y <br />PROJECT ADDRESS <br />Owner Mail Address City Slate/zip Phone <br />c% C r -t <br />Tenant Mail Address City Stalewp Phone <br />Electrical Contractor Mail Address City Statelzip Phone <br />L�Sm��G>� �uzz,r3,Z o.z1�39 <br />Slate Uf ense Number (required) City of Everett Business License Number (required) <br />osed Use of Building Contract Price of Work T c; <br />1� 3: <br />eau, L/ zS^7-•�� ��� <br />Square Footage (If residential new construction, remodel or addition) Contact PersonlContact Nub erl€lpatl F <br />c• <br />r-• <br />� r <br />Number of devices (If low voltage) C' <br />Description of Work to Be Done: <br />N a <br />s• r LM <br />L�l ^ L'1 <br />Y <br />C) QI <br />C7 •,`� G <br />1� <br />�r V <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify, that I have read and examined this application and know file some to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not prosume to give authority to PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construction or Ilia r <br />parfnnnanco of construction. That/ am authorized by thperform e owner of this property to perfothe C <br />work for which application Is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />)0� &"� <br />Signature Dale <br />aEVISEDOW64014 _ <br />