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� <br />ELECTRICAL PERMIT APPLICATION <br />CI �'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www everetriva.org <br />.� �, ��D--/�i <br />.5 Z -s i,✓� ��a �� -- <br />PROJECT ADDRESS <br />c <br />Tenant <br />hta�l Atldress <br />t�tal AdOress <br />Eiectrical Contractor nia�i nadmss <br />� SSCSG FCoBb�✓� <br />State License Number (reqwred) <br />Use cf Ouilding <br />Square Footage (If residential new construction remotlel or addmon) <br />of devices (II low voltage) <br />Descnphon of Work to Be Done <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cdy <br />Ciry <br />nc4� �o <br />Gn <br />C I 4/0�0 %L <br />Sl tclZip Phonc <br />State2ip Phore <br />yz�� <br />t,.d9 9�z9/ ���i-i9T� <br />Siate2�p Pnone <br />�zs 969 <br />C�ry of Everett 9usiness License Number (reqwietl) <br />COntracl Pnce of Work <br />Co�tact Pe�soMConlact NumherlEmail <br />U <br />I hereby certrly lhat 1 have �ead and exammed !!ns applicahon and kno�v the sarne fo be Irue and <br />conecf A!1 proasions ollaws and ordmances gooernmg this type o� �vork nall be comple(ed <br />whefher specdied he�ein or nof The granhng o/ a pemuf does no! presume to 9rve aufhonty f0 <br />violate or cancel fhe provisions ol any olher slafe orlocal law regula(mg conslruction or fhe <br />performance ol construchon That 1 am authonzed by Ihe owner o! this property fo peAorm (he <br />�vork lor wlnch appl�cahon u m de and I comply �vrfh fhe State Confractors La�v 78.27 RCW and <br />296 200 A <br />� ��/�o%y <br />REwSED OBOY'Olu <br />FEE <br />—��00 <br />PERh1ITx <br />E f �t��7- b�Z <br />