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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 /> LI'1-'3 <br /> PROJECT ADDRESS <br /> ADDRESS <br /> 2 a- Yrt.' <br /> '106. '-4 ) <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> 21tN1,14-0,4"N. LL& Y4 t,0) Is1/4444. PL44k (Av.- (si les) toe ipq -444,I) <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> ?it LA/V(4V.q kOgi Ore) (6,D S0 <br /> State License Number(required) City of Everett Business License Number(required) <br /> 3F e istiz) <br /> Proposed Use of Building Contract Price of Work <br /> °LIMA— aie. gt.) s. oc) <br /> Square Footage(If residential new construction,remodel or addition) Contact Person ontact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: QC 1344. otZ) CLYYNIP <br /> FEE <br /> CCD <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> b <br /> thereby certify that!have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work wi//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 ISO 2'11 <br /> work for which application is made and I comply with the•State Contractors Law 18.27 RCW and <br /> 9. 200 WA a <br /> **L. 1 es() A <br /> Signature Date <br /> RevisEcoaower4 <br />