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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVE-ETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — vrww.everettwa.org <br />UafIin �V�) <br />AIR- LOrOm LE <br />PROJECT ADDRESS <br />Owner <br />Mail Addras& <br />City <br />W L�jTqU 205 <br />StateMp Phone <br />Tenant Myail Address,. ' - /city lStmeRip phone <br />Stele Lker�se'f�iunt tber (required)-" — Cry of tverop Business ucense Nmntw, pcyyoM <br />0310�l ao1� LA)o <br />Proposed Use of Building -1$0.4i Contract Price of Work <br />4do <br />Square Footage (If residential newlconsbuction, remodel or addition) Contact PersoNContact Number/Email <br />Number of devices (If low vollage) <br />Descrlpllon of Work to Be Done: V aCcy--\ <br />t, S I'll? a; U t-ndI T <br />whorher vp .`RIP humin rR rRll Tlir yrm tiny 0IO nfmlll doe3 a010m jvin0 10 orvc 04t%rOn)y t0 <br />wolafe or lions of any other state or local law mgufaling construction or the <br />perform of a sWcG . Thal I am aulhonzod by the owner of this property fo perform the <br />walk wl cli app1lc lm rJs adn nd I comply with the State Contractors Law 18.27 RC W and <br />296. 00 W C. <br />Slgnatule Data <br />REVISED asorno is <br />ECG 60. <br />�PERMt I it <br />E I6D�--Wm <br />