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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 />C ISo�-oa5 <br />9SoCA 19-' Aue SE, F--tie—v�4+jyjA) f)80DF5 <br />PROJECT ADDRESS <br />c►+3 ��r�;Pc �n�a-��'�NE �cw <br />Owner Mail Address City State/Zip Phone <br />Aye= -S F F— UP i'Ptf tk %U 9 9-2' ariz— J�S(7 (6 Zl <br />Tenant Mail Address City State/Zip Phone <br />('reei(cv<-�z-ktc A01 RI'r1 rc� SAwG�a�I<<h,Gv�t,9S�a9D �aae� �r-s3sa <br />Electrical Contractor Mail Address City State/Zip Phone <br />GREENC E896N-z- <br />State License Number (required) <br />Proposed Use of Building I <br />Square Footage (If residential new construction, remodel or addition) <br />Number of (If low w voltage) <br />Description of Work to Be Done: <br />!Zt I P. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City of Everett Business License Number (required) <br />fjp00-a0 <br />Contract Price of Work <br />8►� Ndipo� abty 571.535a <br />Contact Person/Contact Number/Email <br />I hereby certify that I have read and examined this application and know the same to be Wn, and <br />correct. All provisions of laws and ordinances goveming !his type of work will be completed <br />whether specified herein or not. Th-., granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other staf^ or local law regulating constmction or the <br />performance of construction. That t am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296,200 WAC. <br />ignature� <br />Rrvisev li'M7014 <br />FEE ----- _ <br />«a-5o <br />PERM[TJI <br />E 4o(-O2 <br />