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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 />16L5 -75" 5T �-J �JGrtTT lr�iN <br />PROJECT ADDRESS <br />Owner <br />C—tsoq�o4� <br />Mad Address Oty State/Zip <br />Address City StatelZ,p <br />Phone <br />Phore <br />N2�5otiE1e�. .� GLjo'Aau-Lie iJ Sj�,-Jol �a -tTLO- i.-iAc*ASuo3 %4523-1Sd <br />Electncal Contrector Mad Address City State/Zip Phone <br />NFLSOF_I i3d.(-Z <br />State License Number (required) <br />(4,- Ae!G%c. <br />Proposed Use of b,:•IAmg <br />Square Footage (If residenhal new construction, remodel or addition) <br />Number o1 devices (Mow voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />cx�jHiU <br />City of Everett Business License Number (required) <br />a T9 M <br />Conlracl Pnce of Work <br />S4� a� 2�oC�.5d3.�i5�-5 <br />Contact PersonfContact Number/Ematl <br />�S�1ab\r��4 ne\5o�elec, u <br />I hereby certify that 1 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 <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That lam authorized by the owner of this property to perform the <br />work for which pplication is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 Wt� <br />I� <br />FFF <br />PERMIT# <br />E 15bq— bq 5 <br />aevrseoososoor. <br />