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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 />3_ AO-(5 <br />fso3—I09 <br />KOS g6�" S4 S\r1 <br />PROJECT ADDRESS <br />PGL c SdtI 0US- S0'- S� 50 E4ele4 WA qyc 3 �bkn <br />Owner Mail Address City State2p Phone <br />Tenant <br />Man Address <br />Cry <br />Statel2rp Phone <br />"El fl e r Eie cihr k . <br />93u- N MID- D- <br />Sjgile- <br />tl z <br />0A- 17$133 2e6 jlle-o <br />Electrical Contractor <br />Mad Address <br />co <br />statelzip Phone <br />5 c�nn2C i 0l�L� <br />State License Number (required) <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done <br />w 1'h Aee+ S <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I K- 14' ere * 5 S <br />City of Everett business License Number (required) <br />Alad 0 d� <br />Contract Price of Work <br />JOS� $c�nnt:; dv <br />Contact Person/Contact Number/Email <br />+ 0 (Ai <br />I hereby certify that 1 have read and examined this application and Anow the same to be true and <br />correct. Atl provisions of laws and ordinances governing this type of work will be completed <br />whether specified heroin 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 />pertomrance of construction That I 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 />29A200 WAC. <br />FEE �^ <br />.C90 <br />PERMrf# — <br />E I5Dq - [()I <br />REVISEOOW&Wf4 <br />