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IELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425 15- f W10 - FAX 42:-: 15-A M7-ti vww.everettwa,org <br /> 5S30 Lz ,, ezi W <br /> PROJECT ADDRESS <br /> 5-4 SS-30 <br /> Owner Mail Address Cly State/Zip Phone <br /> Tenant Mall Address City State/Zip Phone <br /> lhlg k- hLD IS/ LAI P-0 a Dc ZSI d TEAA1 q+1,10� 0,ok 9'0,5 DLL-0-1-1/0 Z)Z <br /> Ele rival Contractor Mail Address City StatelZip Prone <br /> )x/l 7ZkCT251 "24 '9I oa — <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(if residential new construction, remodel or addition) <br /> Number of devices(if low voltage) / <br /> Description of Work to Be Done; rA 5 �A lm' Yuri $ a d✓lr�f� O(� <br /> ef7 I nAyl Mf r) <br /> FEE <br /> �1 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 V <br /> I hem)by certify that 1 have read and examined this application and know the same to be trove and �) <br /> correct. All provisions of taws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not pre sume to give authority to PERMIT# <br /> violate or cancer the provisions of any other state or local law regulating construction or the C <br /> performance of construction. That r am authorized by the owner of this property to perform the C <br /> work for which application is made ano r I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC_ <br /> Signature date <br /> REVI5E0Jl1W13 <br />