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ELECTRICAL PERMIT APPLICATION <br />CITY �f= EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />-���-�!/1�'% /A/I8 �% /% ��r�/I�g.�Q>' <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />QW NE <br />Eledrical Contraclor <br />Stalc License Numbcr (required) <br />S --r2 <br />Proposed Use oi Bwlding <br />Mad Atltlress <br />Mail Address <br />Mad Address <br />G1y <br />Cily <br />StatclZip <br />State2�p <br />StalelZip <br />(P� /O-/�f <br />�1 �//�'-�J`%(� <br />Phonc <br />Phone <br />Phone <br />City ol Everetl Business License Numl�er (requued) <br />Contracl Price of Woik <br />Syuare Foota�e pf resiAeMial new conslruclion, remodel or addilion) Conlar.t Person/Contacl Numbedf_mail <br />Number of devices (I( low voltage) <br />vZyal//iLC3�on) n ayou� a���1�.�) �n �-e�z <br />Descriplion of Woik to Be Done: %�l:/i1%(�Lf'LL/- FI,//�l�Le, /"�I��� ��A /.�u�' �-- -��`-��7.�-'-�' <br />��-�/�)_�Uf}i�l�ll�_ __�UIIL��rn�c>�zi� 3ttP��z_c��PR���i2-- — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hnmby cer6ly Ihaf I havr, road and exanvned Ihis applir,��lior� ar�d know fhe sarnc lo be Iruc anA <br />conecf. �II provisions ollaws and ordinanr,es goveming Ihis typ" nf woik wdl he complefed <br />whr.iherspecdicd hcrein or nnf Thr, gr.+nhng oI a pennd dnr.s no1 presumr, lo grve aufhonl}� lo <br />violafc or canr.cl fhrt provisions o! ony othcr s(a(c or lor.al law regulaling consfrucfion or Ihc <br />pr,r/omi;incc ol consUuction- lhaf I am oidhonzcd bylhc owncr ol (his proporiy (o perlonn 1hc <br />work lonvhich applica6on is made and I r.onrpty wdh fhe Sfafe Confractors Law 18.27 RCW and <br />296200 WAC. <br />�L%�Signali . -- -- -- — "Ua(e��O�/ . <br />r+�. v�si. u osro;n, o i a <br />f-EE <br />�� 00 <br />PERI�1ITt! <br />E ��lc�-' <br />