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ELECTRICAL PERIVIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, lNA 98201 <br />425-257-8810 - FAX 425-257-885? — www.everettwa.org <br />�9�R i��"l-�O(�GfI �L A�/E <br />PROJECT ADDRESS <br />3Go-739-0 <br />At���� �dST�/Z /���'incoov���c-,��� EvERFTr (/v'/,�qg<�o/ <br />Ownef 64ai1 Address Cdy Stale2ip Phone <br />Tenant <br />Eleclrical Contractor <br />�w�✓tk <br />State License Number (required) <br />h-lail Address <br />Ivlail Addiess <br />12FS'�v�Nr,a/�4- _ <br />Proposed Use of Building <br />hi �- <br />Square Foolage (If residential new construction, remodet or addition) <br />/1 / Q- <br />umber of devices (I( low vollage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />Cdy <br />Cdy <br />State2ip <br />Slate2�p <br />Phone <br />Phone <br />City of Everetl �usiness License Number (required) <br />v �3 G�� <br />CoNract Price of Work <br />Contact PersonlCoNact NumbedEmail <br />1 he�eby ceRrty that I have read and exarnined fhis application and know Ihe same (o Ue (n�e and <br />conecL A/l piovisions olla�vs and orclinances goveming this type ol ��orir �vdl be comple(ed <br />whefherspea�ed hemin ornot. The gnnting o/a pennit daes not presume fa give aufhonfy lo <br />violafe or cance! fhe provisions o/ any otNer sfate or local law rcgidafing construcfion or �he <br />perfonnance o/ consf�uc(ion That 1 am aufhonzed by the o�vner ol fh�s property to peAonn the <br />�vorlc for ivhich applicaGon is made and 1 cornpty �vifh the State Contractors La�v 78.27 RCW and <br />296200 WAC. <br />— �� � <br />FEVISED U9�96ROId <br />FEE <br />�� ob <br />PERMLT# � <br />E I �0 1- (� <br />/� <br />