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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 425-257-88&7—vvww,everettwa.org <br /> LDEA :5-r E'4V42-E-17- WA-58201 <br /> PROJECT ADDRESS <br /> tvrl-9- ET--f <br /> Owner Mail Address Ofty statealin Phone <br /> Tenant Mall Address city State/Zfp Phone <br /> 4 5 811.9 <br /> Electrical Contractor Mall Address City statefzlp Phone <br /> TtV 02-67-ZL41 <br /> State License-NUIffiber(required) City of Everett Business License Number(required) <br /> RagaTmEift <br /> Use of Building Contract Price of Work <br /> XVM4M WACIMM 112S-2t8-_(*7044 <br /> -SqLiare Footage(if residential new construction, remodel or addition) Contact Person/Contact NumbertEmall <br /> O/A <br /> Number ddevicas(if low <br /> Descriptlon of Work to Be Done96 me 41 <br /> FEE <br /> CITY OF EVERF-TT LOCAL SALES TAX CODE IS 3105 00 <br /> I hereby cartify that I have read and examined this applIcation and know the same to be true-and <br /> correct. AllprovIslons oflaws and ordinances goveming this type ofwoi-k will be completed <br /> wheffierspecifted herein or not The grantIng of a perm)t does not presume to give authority to PERMIT# <br /> violate or cahcel the pmvislons of any other state or/oca/law regulating construction or the <br /> performanGeofconstrucUon. Thptl am authorized by(,he ownerof Vits property to perform the <br /> E 9 11506-Cr -/--& <br /> work fol wh1cf,application is made and I comply with 11a State Contraotors:law 18,27 RCW and <br /> 296.200 WAG. <br /> 5-19- IS <br /> Signature _ Date <br /> REVISED OWM0 14 <br />