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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 /> 2-930 Maole yVA -7Bzel <br /> PROJECT ADDRESS <br /> �,t�i4e•r �ef+��,�� � 9g3f2 MG4Ie- 5-k gvere+- VJIi 887-&) Zab) 30Z- )3 'Yq <br /> Owner Mail Address city StateOp Phone <br /> Tenant Mail Address City State1zip Phone <br /> t't-+"fy- Exec 4 133ol SE J&vi -T Be*yoe- WA 4W05 423.74-7-57.0L-) <br /> Electrical Contractor Mail Address City Statem <br /> P .Phone <br /> PRIPUEDS4 9r, 7G <br /> State License Number Contract Price of Work <br /> 'yy,g i k'11 i2 J�vara#-ha') N� / Ter ale <br /> oa m _�IeT_�� Cv s <br /> Proposed U of Building Contact Person (Plan Review) 37 <br /> Square Footage(If residential new construction,remodel or addition) <br /> ....._........ .......... . .............. . <br /> Number of devices(if low voltage) <br /> Description of Work to Be Bone: 12g?.njo carna remave (q) "�7w001v and in q fj 07 :9eki <br /> wre 5 nc J trackt� rel Z) sWikhds (i _fjle err f / 7rele ✓rc� <br /> 0% [52} Fluor hn xes• J14 ii Ambi l �17�f S 5`1. Le ve l 2 wa,V room &I LL5 u1 Z <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> # ?�522� 3 <br /> I hereby certify that 1 have read and examined this eppGcation and know the same to be true and <br /> correct. All provisions of laws and ordinances goveming this type of work will be completed <br /> whetherspecifiedherein ornot The granfingofapermit does not presumetogive authority to PEi MIT# <br /> violate or cancel the provisions of any otherstate orlocal late regulating construction or the <br /> performance of construction. That/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 /> 296.200 WAC. <br /> Signature Date <br /> REVISEDWM3 <br />