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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 />( oz8 WFff w�M���� ✓i�w �— <br />PROJECT ADDRESS <br />Owner <br />Mail ACOress <br />Ciry <br />State2iv <br />l��JI � <br />� 1 K o �—� a-7 <br />Phone <br />�u,�� �►���y��►� x�,�ar��,t <br />Tenant h1ai1 Adtlress Ciry StalelLp Phone <br />1�i �eN,J� SIG1✓ CO/�/1 ILf.f G✓'Ef���/lyF/`� Sr9ffL� 981d9 Za6—Zd2—o7/v <br />Electrical Conlraclor 61ai1 Address Ciry State/Zip Phone <br />�/A�(rosco3�M3 _ <br />Slate License Number <br />Proposed Use ol Build�ng <br />Square Footage (If residential new construcUon, remodel or addition) <br />Number of dev�ces (If low voltage) <br />,� �ad.00 <br />Contracl Pnce of Work <br />S�'�✓� Zl�m���l�✓ <br />Contact Person (Plan Review) <br />Description ol Work to Be Done�. (�y��`C � a / '��M�'u��0 W'� "" J'" � � <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 31U5 <br />1 hereby certity that 1 have read and examined Ihis appGcalion and kno}v the same to be fnie and <br />correct. All provisions o( laws and ordinances goveming Iliis (ype o/ worh wdl be complefed <br />whefher specified herein or not. The ryanhng ot a permd does nof p�esume to give aulhonty fo <br />violafe or cance� the provisions ol any olher slate or local la�v regulafing consWction or the <br />perfomiance o/ constn�chon That 1 am authonzed by Ihe o�vner o/ this property to pedorm the <br />work (or which app calion i made and I comply wifh fhe Sfafe Conlracrors Law 78.27 RCW and <br />296 200 WAC. <br />/ ��0%/'� __ <br />BFV:SF0100/IJ <br />FEE <br />clb.0� <br />PER�1ITk <br />E 1 �(07��0 <br />