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ELECTRICAL PERMIT AP�LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425257-8857 — www.everettwa.gov <br />�5\1 1� Av� S� Y�ve.r��,'vJA °I��B <br />PROJECT ADDRESS <br />`�lTL1 1an.� Mq��4�en Pac�sl, �5�� 1t4, ��� SE E <br />Uwner hlail Address Gty <br />Tenant <br />CT � o� <br />ElecNcal Contractor <br />GT Nc�RT L�`L1 Ms <br />Stai� License Number (reqwmd) <br />Proposed Use of Building <br />1.1ai1 Addmss <br />P.o.� <br />Address <br />Square Footage pf resideMial new wnsirudion, remodel or atlditi�n) <br />Number o( devices (If low voltage) <br />c�ry <br />� iSoB-065 <br />g—�� --�s <br />WA 982v8 <br />Slate2�p <br />Slate/Zip <br />�18�-33 <br />Stalef� <br />o�ao3� <br />,3 - I21� <br />Phune <br />Phone <br />L`I - L21,2 <br />Phonc <br />Ciry of Evte'rett Business License Number (reqwred� <br />�f' � '� .GG <br />-�P <br />ConVad nGc o` Work <br />lirG1�C IVi(%����/��"'Y_tiP�� <br />Contad eNContact Numbed mail <br />Descnption ot Work lo Be Done. I� S�C1 I{ ��� ? n e� ��� I��+ � �� ��� <br />�� ��� � ���-, I- ���f �s ��-���'�(� r k �� l� �- <br />CITY OF EVERETT LOCHL SALES TAX CODE IS 3105 <br />1 hereby certdy fhat 1 havr, read and examrned fhls app6cabon and know the same to be hue and <br />correct All prov�sions ollmvs and ordmances govemmg fhis rype o! work will he completeU <br />whether speci6ed herein or not The granfing ol a peimd docs not p�esume to 9ivr, authonty !o <br />violate or cancel fhe provisions ol an� ofhe� state or local law iegula�ing consfn�chon or fhe <br />peAormance ol conshuction. That I am aulhonzed by the owner ol this pioperly fo perlumr the <br />work lor which pDcahon i�� e ar I cornply wi(h fho Sfafe Confractors Law 18 27 RCW and <br />296 200 W <br />r <br />'��_�.� <br />REVISEIJ Oft9l:Vla <br />FEE <br />�(aa- �� <br />PERMIT�I <br />E (so8-ot�5 <br />i o+l <br />