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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� � t�K'�rri�� �L� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />�` `-L <br />Mail Address <br />Mail Adtlress <br />Ci�y <br />City <br />State2ip <br />StatelZip <br />7--a-� 3 <br />E �30���01 <br />y�s �1,2d <br />� y3� <br />Phone <br />Phone <br />3G o <br />�a35 '�bU �S� v��,'n 5!- �')r�✓�✓r�P 1 J(-�- `1���1 7�1 �3�'0 <br />ElectYical Coniraclor Mail Address City State2ip Phone <br />C�N �,R C,-�' ��°,��r <br />State License Number <br />� i� F <br />, <br />Proposed Use of Building <br />1(�C� <br />Square Foolage (If residenlial new construclwn, remodel or addition) <br />Number o( devices Qf low voltage) <br />Description o( Work lo Be Done: <br />�^�/i�� �n�r���o r�'�/�C�v�t�r� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />��c4��t9d <br />Coniract Price of Work <br />Bil I„ !�Gll �s <br />Conta t Person (Plan Review) <br />I herr;by ceriify that I have read and examinec fhis application and knowlhe same to be true and <br />conect All provisions olla�vs and ordinances goveming this type oI work will be cor, �plefed <br />whether specilied herein ornoL The granfing o/a pennit does nof presmne fo give authonty fo <br />violafe orcancel lhe provisions olany otherstate orlocal law regulating cons6uc(ion or fhe <br />pcAonnance ol consfruction. T/�at 1 am authorized 6y fhe o�vner o(tHis properiy to pedomi the <br />�sork lor �vhich applicafion is made and 1 comply wifh the State Confracfors Law 78.27 RCW and <br />296 200 WAC. , <br />;. �_ crsrn vzai3 <br />FEE <br />�� , <br />Uv <br />i <br />PERMIT# <br />E13o-� _ oi0 <br />