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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi', WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�Oo � SC �-�f �1ti1( ��y ��- � � i- <br />PROJECT ADDRESS <br />2ob��+sovt <br />Owner <br />� eGInGV� <br />Tenanl <br />��e <br />E Iectrical�Contractor <br />7,,� „�,v-j-i e S � <br />�_�v�`M11ail Address <br />A:l(��2. iDO�] ` <br />hlail Address <br />ni� 1�30� anh. <br />Mail Address <br />k n� � � c-��t �o� �S1 <br />Slate License Number <br />� �Cl1�a+r� <br />Proposed Use o( Building <br />.� <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (It low voltage) <br />Description of Work lo Be Done� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Ciry <br />5 Pr� <br />Ciry <br />Stale/Zip <br />�— l�� l4)dl ���' <br />Stale/Zip <br />� M���GYYP.�A�BOi2`�"� <br />State/Zip <br />� Soo � <br />Contract Price of Work <br />Contacl Person (Plan Revie�•Q <br />Phone <br />9� <br />Phone <br />1-�`i� <br />Phone <br />1��..,-1e�� vu. o� � e r-t �' — <br />1 hereby cedify fhaf 1 have read and examined fhis application and know the same to be frue and <br />correcl. All provisions olla�vs and ordinances goveming this type ol work �vill be complefed <br />�vhether specificd herein ornoL The 9ranting ol a pennit does nof piesume to give au(honty fo <br />violafe or cancel fhe provisions o! any olher stalc or local lavi regu/a(ing conslruction or the <br />peAormance o/consWction. Thaf 1 am au�honzed by the o�sner ol this property lo perfonn lhe <br />wodc lor which application is nrade and 1 comply wi(h fhe Stafe Contracfors Law 78.27 RCW and <br />296.200 WAC. <br />%�,�L W W� <br />rn�iseo;:an <br />FEE <br />5-(• 5� <br />PERMIT� <br />E 13tZ -v31 <br />