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ELECTRIC//S►L PERMIT APPLICATIQN <br /> CITY OF EVERETT PERMIT SERVIC�S 5_ �s-13 <br /> 3200 CEDAR STREET, EVEREI?, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everetiwa.org ��30 S—Og� <br /> I c� tz � z5�h V+v � Sj= <br /> PROJECT ADDRESS <br /> � � <br /> Owner <br /> Mail Address Ciry StatelZip Phone <br /> Tenanl Mail Addr<,ss City State/Zip Phone <br /> ` /� Z�G <br /> �l �1UrI�� �1 Pl �v�L 2�\ � S�J ��� �nr� S� l P f1�� WAY W f`}' Afi�62� bsl -7i��d <br /> Electrical CoNraclor Mail Address C�ry <br /> Slate/Zip Phone <br /> N <br /> N� �ol�✓� 88 Y KN � �c� . �— <br /> State License Number Coniract Price of Work <br /> Proposed Use of Building Conlact Person (Plan Rr view) <br /> Square Foolage Qf residential new construction, remodel or addilion) <br /> Number of devices Qf low voltage) <br /> Description of Work to Be Done: ���!C(�� �Q � � ���, <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� �� <br /> 1 hereby certily thaf!have read and examined this application and know the same to be We and _ <br /> correcL All provis�ons o(laws and ordinances goveming this type ot work will b=completed <br /> whefher speci�ed herein ornoL The granting ol a pemiif does not presume to give authonty fo PEi2MIT# <br /> violate or car,cel the provisions o(any ofher state orlocal law regulating constniction or fhe C � ��� n��y <br /> pedom�ance ol consfruction. That!am authonzed by the owner of this property lo perform the �— �J O <br /> wo�1</or wAich application is made and 1 comply wilh the Stafe Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �� � �i <br /> It /�i�-� S � IS �Z015 <br /> f-''�� Date <br /> -�` �Signature <br /> REVISL-'U 9RQ�13 <br />