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r-1 <br />Am <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 FAX 425-257-8857 — vAvw everettwa org <br />�1� 2 a kir„rdeSy� L. -z4 A�- r <br />PROJECT ADDRESS <br />V > �)o cD`3 -1�e- Loe- LOB- 6*00 5 <br />Owner Mail Address City StaterZ,p Phone <br />Tenant Mad Address City State/Zip Phone <br />co( 1' ��� �.tm 5 `�3tt �S �Iruaj t GI£y"53 Wts1ti <br />Electrical ConlraClO Mail Address City Stale/21p Phone <br />&.a(0mg� �,c7v-c) <br />Slate License NumbCer� Contract Price of Work c <br />( oiA M <br />Proposed Use of Building Contact Person (Plan Review) <br />?--0 t mm <br />Square Foolage (If residential new construction, remodel or addition) <br />Number of devices (It low voltage)�� <br />11 Description of Work to Be Done: �DCzac <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the sarne 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 PERMIT# <br />violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the E ( -1 <br />to <br />work for which application is made and I comply with the State Contractors Law 16.27 RCW and <br />296,200 WAC. <br />Signature wale <br />REVISED WM3 <br />103D j <br />