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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 />PROJECT ADDRESS <br />Goa-41(a- Plotzu 0614,L1C tall 50 5LAuellyYo Porffi.,id OK 77-a0Y <br />Owner Mad Address City Slate2,p Phone <br />ot1�t+sifercff it 98o?0 <br />Tenant k 8 <br />Mail Address Gty Stale!Zip Phone <br />�e((�.3j$j SV'5 F rnT --'J-YO0 ilE rriesdw Rd. F✓e(o-f - WA 0o3 <br />Electrical Con aclor Mad Address City Slate/Zip Phone <br />15b&Y/1C-OFZ3 <br />State License Number (required) <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: NO 6 k <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />oay�ff6 <br />City of Everett Business License Number (required) <br />100,00 <br />Contract Price of Work <br />N(L� L cobs <br />Contact Person/Contact Number/Email <br />i1ewPerNlt}sQ �fl'ys��"S�en,,,co+� <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 />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 made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />5 <br />REVISEDOMIC114 <br />FEE <br />50 <br />PERMIT# <br />EN12- 1qT <br />