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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 /> X31 ea:I ry <br /> PROJECT ADDRESS 1 I <br /> J`O i(�Y\� <br /> Owner Mall Address City State/Zip Phone <br /> Tenant Mall Address City State/Zip Phone <br /> 2(MAANA�tN "- !M 91.0) 13 ISL Wa q X81 k08 W. a q 8 o <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> ehW\"\#.Q koa Do Oa (6a 3 0 <br /> State License Number(required) City of Everett Business License Number(required) <br /> s�2 493bo <br /> Proposed Use of Building Contract Price of Work <br /> GlU 1-� fl� . q�. qq DO <br /> Square Footage(If residential new construction,remodel or addition) Contact Person/Contact umber/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done; a13110 -4-- S-k 0-1 4'�k C-I"1 < C— <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that l 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 IKv� <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> :I: / <br /> Signature Date <br /> REVISED OWM014 <br />