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ELECTRICAL PERMIT APPLICATION <br />PROJECT ADDRESS <br />Vjeil ----?soo <br />Owner <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettvva.org <br />(D <br />2ov- <br />Mail Address I C.ty State'Lp Phone <br />4-1- <br />frlae- --- <br />TenaMail Address City state/zip Phone <br />O <br />�.e�arrr��vt PQw,-JCL sp3-23t-�12t!�L` ►Il)pmll,'Ke WM, w ?&Ws a R <br />Electrical Contractor Mail Address City State/Zip Phone <br />CcVEST"op/- 9-� <br />Slate License Number (required) <br />Propose 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: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 (930 <br />City of Everett Business License Number (required) <br />t {S0D. -)o <br />Contract Price of Work <br />pi;Ke Lihis4ym1, 2O6-Zoo-s3�s� <br />Contact Person/Contact Number/Email <br />�i F,}.o,•rcl � rm �a �ve�L1t �l+»; 1, r <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 granling 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 1 am authonzed 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 />_ 6 NX16 <br />Signature ,{ _ fete' <br />FEE <br />7500 <br />PERMIT;! E 150(o -03 _ <br />REVISED0&V&20r4 <br />