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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.gov <br />�� <br />,� � ��-�CUf�'ft'l I.�JCi�.i <br />PROJECT ADDRE S <br />� <br />Owner <br />Mail Address <br />City <br />State/Zip Phone <br />�r �� �� M� t r�� � � Z.�c� i,��- a r�,� �� l�cua �"�'�:-(-�I-- i,���fi � �� �2� 3 <br />Tenant Mail Address � State/Zip Phone <br />3�� K `Y -� 3� � <br />, � <br />Y;uf,� `��%at1 `-� f�ri►l�i'�5�(�r 2LG(�`b i�7,i�.� ��l �- �v1 Ulx�1���'���?ly�, 11� ���7 <br />EI <br />F.� � � Cc� � �� �i <br />State icense Number (required) <br />�C�r _ n� �( l.0 i S il 1 �7 <br />Proposed Use of Building <br />Mail Ad'dress <br />Square Footage (If residential new construction, remodel or addition) <br />_ ) <br />Number of devices (If low voltage) <br />City <br />State/Zip <br />Phone <br />� 4'sG� �i <br />City of Everett Business License Number (required) <br />�. - <br />. <br />Contract Price of Work <br />5 �'� �itci �t �I �ti�� U �ii51' <br />Contact Person/Contact Nu ber/Email <br />S��GI �(1 ���W (�,� �� i 5 i G� 1'� . � G�^� <br />'�/.?� �"r2-1.�-��.Z� <br />U <br />Description of Work to Be Done: � ri �}7(� � 1(� �l � n l�V(..� �.iJ �((.� � � I C� l�_5 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I 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 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 Vl/AC. <br />_ �_ . n <br />Signature <br />REVISED 08/O6/2074 <br />FEE <br />������ <br />PERMIT# <br />E ��� -2�2 <br />