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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERV�CES <br /> 3200 CEDAR STRFET, EVERETT, WA 9820'1 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereltwa.org <br /> � <br /> � n /� <br /> / `�T�tCv�K�'YL T1 u� � <br /> PROJECT ADDRESS <br /> (��wR�s �2o�Q ���� (L��k��. N �t_l� �� �A `f2s-33�t - �3�t1, <br /> Owner h7ad Address City Stale/Zip Phone i <br /> II <br /> I Tenanl Idail Address City State2lp Phone <br /> y2S-4�-��s <br /> L.o��w �ct{L��1�W c 1 o�zS/�7�itur-�c- SNoKor��M ��a `�g 2�� <br /> Eleclrical Contraclor Mail Atldress City Stale/Zip Phone �, <br /> ���_ ,�e�i9 ��cr�r= � D�1loD5�b <br /> State License Number(required) City of Everett Business License Number(required) <br /> �7C � �n <br /> Proposed Use ol Building Contracl Price o1 Work <br /> Square Foolage(If residentiat new construction, remodel or addition) Con�act PerSonlContacl NumhedEmail <br /> Number ol dew�Qf lovr voltage) I <br /> Description of Work to Be Done: /1�� � �^< <-LSS —C� ����� �� <br /> 0� N � ;rs�,� vom <br /> � � <br /> � <br /> fE[ <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS J105 � �D� �� <br /> i <br /> I hereby cerlily(hat I have read and examined fhis app6cafion and know the sarne fo be fn�e and <br /> cortrct All provisions ollaws and ordinm�ces goveming this type o/work�vill be complefed <br /> �vhetherspec�(ed hemin ornoL Thc gnnting o(a pemiit does no(presume fo give authonty lo p[RMITr <br /> violate or cancel!he provisions ol any ofher s(ate or local la�v reyulafing constn�ction or the r I��— O�O <br /> peifamance ol consfn�c � n. hat I am aidhorized by Ihe o�mer o/fhis property fo peAonn the t <br /> work Ior�vhic applica(i n is m e and 1 compty witb(he Stale Con(ncfors La�v 18.27 RCW and <br /> 296.200 WA . <br /> � � �� <br /> ignaNre ��� <br /> FEl'ISFOCdCNd01J _______"___ --_--'--"---� <br />