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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 3 ` <br />E 15�3-165 <br />7e ZS /Mr_ 170�je-LL Ale - <br />PROJECT ADDRESS <br />yLs- ZSL- <br />�o 76/� <br />Owner Mail Address C+ty Stateizip Phone <br />Tenant Mail Address City State/zip Phone <br />4/zS- <br />lt)ehsco 4Lr:&-rY7�L- we- 615a 97�5%.dam 6'✓Jar�SYLtP w� 9f2-70 30 vX79 <br />Electrical Contractor Mail Address Cdy Slatelzip Phone <br />tA) 5 9 3h 91 Z6/ <br />Stale License Number (required) City of Everett Business License Number (required) <br />5-00 <br />Proposed Use of Bd.lding Contract Price of Work <br />�zg,T °Jr%5-317-av�� <br />Square Footage (If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br />Number of devices (If low voltage) <br />Description of Work to Be Done: 6�' 0 61 /LGwr 7- <br />(� <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <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 granting of a permit does not presume to give authonty to PERMr.-# <br />violate or cancel the provisions of any other state or local law regulating construction or the I `� 1 �C <br />performance of construction. That/ am authorized by the owner of this property to perform the t t� ` J <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296,200 WACC.�. <br />Signature Dat <br />rervseo ouosrzo ra <br />