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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 /> mEjer-J L L- ozfE k 10x1gkM9-'1 <br /> PROJECT ADDRESS <br /> MiuliEk PWo �W7-165 U-C% ,23i0 Hwyg9 )c- v 1�e6r y,g?o y <br /> Owner Mail Address City State/Zip Phone <br /> �-t PPEN5 Goo <br /> Tenant Mail Address City State/Zip 1/237- 337 3 Phone Oy 5j <br /> ,CIIZ5r 6&r✓ i5l,6 0VIC /Vz.6 OAkE-3 AW6 - IEU2e 7 - 9820 / <br /> Electrical Contractor Mail Address City State/Zip 1/237-' .?68'Phone760 <br /> rC& `T7 R c 75-00 <br /> State License Number � Contract Price of Work <br /> r ( <br /> Proposed Use of Building Contact Person (Plan Review) <br /> 5-0,cicc <br /> Square F otage(If residential new construction, remodel or addition) <br /> tv/A <br /> Number of devices (If low voltage) d2),/ ,/ <br /> Description of Work to Be Done: 77o� Cleca/737 ( we Ide rs / 1,42-6 � <br /> C PA44 E- Aoop- OPC'N&e. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> l hereby certify that/have read and examined this application and know the same to be true and l <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 lam 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 <br /> ,S 6�j <br /> i►'U� /z l,� l <br /> Signature Mate <br />