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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 (fl 2Z-( V; <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />AMW <br />JWIIEFF-21 lC� r� mac( 64 e �2�L�zo i <br />PROJECT ADDRESS <br />)00�da,( 2?o2 Corbq #IZZ-Dr� s�ff 1 <br />Owner rAall AddreSS city <br />StatelZip Phone <br />Pr (C-�')db- 2-710 6✓c�v,4 Aue 1= Vc,,retl LjA55 2el (42!5- 3�4-3647 <br />Tenant Man Address City Statelbp Phone <br />Contractor Mao Address <br />PuGE TsP i3(!:n �)3 — <br />State License Number (required) <br />oF,=rc� SPA <br />Proposed Use of Building <br />(evn() del �,(� 1 Fr <br />Square Footage (If residential new construction, remodel or addition) <br />30 <br />Number of devices (If low voltage) <br />Desrnplion of Work to Bo Done ( N <br />�r1�L7uyt , WIj q<bi:Vy 20G C lfr-433� <br />City St2ler"p Phone <br />c1.01plij �. 10641I <br />City of rest Business License Numi (required) <br />i, vtn 4 CPieCn ' 6oi) 4 , - <br />Contract Price of Work <br />je,r-L( I-(2rdV-ul-kfu - <br />2o6(-!- 43 � - <br />Contact Person/Contact Number/Email <br />'%rr-(I k"-v"4 f 1 Nk5-'- (ENc,r64 ylCf <br />(crrvS <br />7 I l4-12 h ,-) "%A ya4e `� IJD (d--2 Z D 1� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have reed and examined three application and know the samo to be We and <br />correct. All provisions of laws and ordinances governing this" of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give aufhonty fo <br />violate or cancel the provisions of any other slate orlocal 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 1 comply with the State Contractors Law 78 27 RCW and <br />296.2001r 6, , /] <br />0- <br />FEE `� <br />50 <br />PERMTTtt <br />E 11=i30 <br />4E115EDU,1W011 <br />