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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 />u Is- i4oc7-03 <br />\n'e+r„r9rn- Ave. n 161 �:IOt7f <br />I PROJECT ADDRESS <br />Owner Mad Address City StataZip Phone <br />G;r_l_ SLO'is bot v�5j,_Se.:�If— wA gBloy_ 4as-04,ti b <br />Tenant Mad Address City Sate/Zip Phone <br />hILL -)t-\PR1-ynP— i5 E L` -AIV\ 5]�Q icu,.i wA 992oA 7u6 �c3�9g1 <br />Electrical Contractor Ma I Address City State/Zip Phone <br />-EC. BLTEL(,-12) 53 <br />State License Number (r -gwred) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />o agLS� <br />City of Everett Business License Number (required) <br />0 ]1 9oo.00 <br />Contract Price of Work <br />J���Lss4';est� �ob-�63-99�1 <br />Contact Person/Contact Number/Email <br />fJ E7 J " ,B b\rwkboY' Cow\ <br />Number of devices (If low voltage) 1 <br />Description of Work to Be Done Lbw Vey 11- i e -yo : r-� k V)Au - <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CCDE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be tine and <br />correct. All provisions of laws and onhnan. �s goveming this type of work will be completed <br />-- <br />whether specified herein or not The granting of a permit does not presume to give authority to <br />PERMFT# <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />by the this to i the <br />C <br />6 3 Lf <br />pertomiance of constriction. That I am authorized owner of property pertom <br />(111� Ia�I <br />L — <br />work for which application is made and I comply with the Slate Contractors Law 18,27 RCW and <br />_ <br />296. 200 WAC. <br />PEvisEe ONffi40ra <br />