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t n>iN6-- i nm-r 0 0 6 <br /> 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 /> .2300 merri I) Gree1e— '<.wy <br /> PROJECT ADDRESS <br /> RI N1ex- IV-0LLC I Z310 )owl °19 - Ge-518* ,km - q R Zo y Nli� <br /> Owner Mail Address City State/Zip Phone <br /> .2600 (ttit 3-)-. S 1N -.Su m 150 1$2 4 4 <br /> Tenant Mail Address City State/Zip Phoneo <br /> yz s- 353-0 ys <br /> es'a' G c• t�ZG 04e-O'S ALF-- EA9- y F UJA 92201 (1 Z,s-.26 - <br /> Electrical Contractor Mail Address City State/Zip Phon%60 <br /> FI t5rcE- q I (Z C y,21 000 • 00 <br /> State License Number Contract Price of Work <br /> rffi I-I Nj�- �fYk4�U 1� �Ji�t(�--- S UM 0�.11�j <br /> Proposed Use of Build ng Contact Person (Plan Review) <br /> 7-010 <br /> Square Footage (If residential new construction, remodel or addition) <br /> N L'6' <br /> Number of devices (If low voltage) `,���� <br /> Description of Work to Be Done: T �' `�-�'Y � C0l�; p "N-� <br /> 9A I L:t, Qx 00AG ( 3Q)NW 1-rv'*ts ( 6 5-) - <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I l -2j h <br /> l hereby certify that 1 have read and examined this application and know the same to be true and Ov <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 PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the (� <br /> performance of construction. That I am authorized by the owner of this property to perform the E (W19 19 / 7 <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> to <br /> ignature Date <br />