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ELECTRICAL PERMIT APPLICA=ION <br />�3��1 <br />PROJECT ADDRESS <br />� I � � <br />Owner <br />� <br />r� <br />Tenanl <br />Elecirica- — Contractor <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />Y✓1 � h r d�2 <br />�� <br />State License Number <br />I�eS`�°��-�-�-�P , <br />Proposed Use o( Builtling <br />Mail Address <br />Mail Address <br />�dail Address <br />I���� S�4 �F'+� <br />Square Footage (If re ential new consiruclion, remodel or addition) <br />Number o( devices (I( low voltage) <br />Description o( Work lo Be Done: 'e- �"'l� �— <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />q-a3-�3 <br />L i 309—��,� <br />��2n� <br />r ST �bM �►�,J%S <br />Slate2ip <br />,N,Q� vcv-� t 1/C� <br />City Stale/Zip <br />Gry State!Zip <br />��- s��� <br />Phone <br />69l ' <br />< <br />Phone <br />Phone <br />/» vJ U <br />V <br />Contract Price o� Work <br />�h, �95 yT�S_�� � I <br />Contact Person (Plan Review) I <br />2c�a � r�l <br />1 hereby ceAily fha� I have read and examined this applicalion and know the same to Le fnie and <br />conect. All provisions of la�vs and orUinances goveming this type ol work �vill be cornpleted <br />whefher speci�ed herein ornot The granfing ol a pemii! does nof presume to give authonty !o <br />violafe orcancel the provisions ol any ofher s(ate or local law rsgulafing consWcfion orthe <br />peAomiance of consWcfion. That 1 am authonzed by fhe ownero/ fhis property to peAomt the <br />work lor which application is nmde and I comply wilh Ihe Stafe Confractors Law 18.27 RCW and <br />296200 WAC. <br />i+EvisFo a,�ai� <br />'.�y'�%��e <br />FEE <br />��-DO <br />PERMITn" <br />E l ��� - /(� <br />