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ELECTRICAL PERMIT i4RPLICATION <br />CITY OF EVERETT FERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4::5-257-8610 - FAX 425-257-8857 —www.everettwa.org <br />��; �� �:� /�,,,�.��� �t �, <br />PROJECT ADDRESS <br />,-�, �r�,�. <br />Owner <br />Tenant <br />�>n <br />�F�� �� <br />Mail Address <br />Mail Address <br />./�irt;� �G�i <br />Contreclor Mail <br />7 <br />/�P�4n;�. (� ��� .� G <br />State icense Number <br />Pr000sed Use of Building <br />Square Footage (If residential new wnstruclion, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done <br />CI fY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />6—�—�3 <br />Er3o6-l�16 <br />rf���' ll"«- <br />Ciry State2ip <br />City <br />le�- � <br />City <br />StalelZip <br />f�.1,/ /�� �� <br />State/Zip <br />� <br />rnone <br />Phone <br />��f-' �`�,d•�: �, <br />Phone , <br />�l�� <br />ConV cl Price of Work <br />�nDi s <br />Contact Person (Plan Review) <br />�� „� ,�l,,f�s c� ,�y�ti �'i�f�-> <br />I bereby certily that 1 have read and examined fhis application and know fhe same to 6a true and <br />correct All provisions o/laws and ortlinances ,qoveming this type o( work will be complefeA <br />whefher specified herein or noL The granting ol a permit does not presurne fo give authonty fo <br />violate or cancel the provisions o/ any other sfate or local law regulating construction or fhe <br />perfonnance olconstruction. That 1 am nuthonzed by fhe ownerolthis property fo perform the <br />work /or wbich ap lication is made and 1 comply �+;;h the Sfale Confmctors Law 1827 RCW and <br />296.200 WAC.� <br />,�-,��. ��� ���'�-� <br />Signature Da1e <br />FEE <br />50�00 <br />PERMIT# <br />E � 3C���'�1�� <br />