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10/05/10111 20 1? C553/ I, 0C1/003 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVER TT PERMIT SERVICES <br />3200 CEDAR ST EST, EVERETT, WA 98201 <br />j 425-257-8810 - FAX 2a-257-8857 — www.cvcrettwa.org /b ` D b— l y <br />El4io-oyo <br />ry <br />PROJECT ADDRESS ✓ ) <br />Owner Mad Address city sfak2p Phone <br />Tennnt Mad Address City State/Lp Ptmna <br />Flectimal Contractor Mail Address City Slato/A'p Phone <br />2-V 01 to 30 <br />State License Number (required) City of Everett Business t ieense Number (required) <br />Proposed Uro off Building ContiraSt Price of Work <br />Square Footage (If residential new construction, remodel or ddition) Contact Person/Contact Numoer/Emad <br />Number of devices (If low voltage) <br />Description of Work to Be Done! ClIteill7yri 43L_' /tit �Q /j(I /`iJ�j(�rfffjt <br />/� <br />CITY OF EVERLTT LOCAL SALES TAX CODE 15 3105 FFF <br />I hereby certify that / have read and oxamined this appbcah and know tho same to be hue and <br />Correll All provisions of laws and ordinances governing th! type of wwk will be completed <br />whether specified heroin or not The granting of a pnnnif do is not prosuma to givo authority to PERMIT# <br />violate of cancel the provisions of any other state or local le regulating construction or file ^ I O _ 00 <br />performanco of construction. That 1 am Authorized by the o ner of this pmpatfry to perform the work for whit ap nation 13 made and I comply with tho Stilla Contmernis Law 18 27 RCW and <br />296 200 Wol <br />tpnalure - - / p — <br />cv�uoowexw <br />