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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 08201 <br />425-257-8810 - FAX 425-257-8857—www.everettwa.org <br />4101 RL.d<-e-r EISes`f33 <br />PROJECT ADDRESS <br />j r t''�CV Ml `/lo(I ockc`Avc were C&If_i -s6on1Goc <br />Owner Ball Address City Stalc0p Phone <br />Tenant Mail Address City SlatUZip Phone <br />Ell I.So09 'S qq , Aili I�ST _yNnwood t,//ll?go 7 WS7yi3S <br />Electnral Contractor Mall Address Ci Staretzlp Phone <br />FNFty,GMs913a6 -- <br />State License Number (required) <br />Proposed li Building <br />Square Footage (It residential new constnrction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done. �A(k i A d G 0 + <br />CITY OF EVERETT LOCAL SAI.FS TAX CODE IS 3105 <br />0q,? -000 <br />City of Fverett Duslress License Number (required) <br />—jI,Sao _ <br />Contract Price of Work <br />lAuarll C Ie, 66 A (17 SM1 Sz 6 <br />ntact Person/Contact Number!( -mail <br />(Nt S�Q P (M S i U) CL. C o Lin <br />I hemby ceriPy !hnt 1 hnve read and examined this application and know the same to be true and <br />correct. All provlsinns of laws end onlinancl:5 govcming this type of work will be completed <br />whetherspeclhed here/n or not. The g,anting of a permit does not presume to give authonty to <br />violate or cm;rr%1 the pmvlsions of any other state or local law regulating construction or the <br />performance of construction. Thnt I nm authodred by the owner of this property b perform the <br />work for which application rs mode and I comply with the State Contractors Law 18.27 RCW and <br />296,200 VJIJG�^ <br />S 22 24 l S <br />de"io LGi) <br />FEE <br />z7z' D <br />PERMIT# <br />E 1505- [ 33 <br />FFWSFD D&VWars <br />