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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 /> ?909 - 1e � �%, 9k20: <br /> PROJECT ADDRESS <br /> IM'Ls- / S 9909 - zy4h LA 3E 67/2 ?E77 r /v4, 9208 v2s-33 <br /> Owner Mail Address City State/Zip Phone / 40/ <br /> �G vz.5760T.77 <br /> Tenant Mail Address City State/Zip Phone <br /> y.5r�7L <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number ( `( <br /> Contract Price of Work <br /> r. <br /> 2J- -Ic cc �n ; I <br /> Proposed Use f Building Contact Person (Plan Review) <br /> U4de Yaa s'' <br /> Square Footage (If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: y - Ca-72 byth i`2 eR 4 G' <br /> is / - JD' i'2;' h 3 o°9J leX ; Cw<d -30 #727 <br /> e. (lecJ /v St' room F00r97 hie 4,12 ' e-/ c ,9i.?�/� / <br /> FEE <br /> �c <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1" J <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E 11j O(o - -1)67 3 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> te, 6/C1)/fir <br /> Signature Date <br />