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Ir IBM <br /> IOG�q O yZ36 /7 <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 /> GOV <br /> PROJECT ADDRESS <br /> r T �o PoX 370 aS� �� 9;?12 Z 707 --1-Z6. 3-1'Z•z/z / <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 4�M )eefc 9 9�z_ 0 05 99 <br /> State License Number(required) City of Everett Business License Number(required) <br /> _ <br /> 15"'900 <br /> Proposed Use of Building Contract Price of Work <br /> A�k/".H/�M/7ha �T c� <br /> Square Footage(If residential new construction,remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 2� <br /> l hereby certify that/have read and examined this application and know the same to be true and d <br /> con-ect. 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/am authorized by the owner of this property to perform the C lO <br /> work for which application is made and I comply with the State Contractors Law 16.27 RCW and <br /> 296.200 WAC., <br /> gnature Date <br /> GENERAL CONSTRUCTION COMPANY <br /> M P.O.BOX 46-MUKILTEO,WA 98275 <br /> REVISED 081068074 E%/ ' 425-294-6944-FAX-425-294-6947 <br />