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BURKE ELECTRIC LLC Fax:4257475977 Dec 8 2014 10:39am P001/001 <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 /> 706 04 fro ,4vd- 56 . <br /> PROJECT ADDRESS <br /> PAcf 1c apse /ons .t4 ? c <br /> Owner Mail Address City State/Zip ! Phone <br /> Tenant Mail Address City State/Zip Phone <br /> 52 - ELIC / � '�� � � „ Y' QoL <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State LicensensNumber(required) City of Everett Business License Number(required) <br /> 1 4 ,To0 0. t <br /> Proposed Use of Building Contract Price of Work <br /> /INVA r <br /> Square Footage(If residential new construction,remodel or addition) Contact Pe on/Cont Number/Email <br /> rq j AZA vtAse-J e <br /> Number of devices(If low voltage) w+ <br /> Description of Work to Be Done: Li <br /> lit C T' 4 peieot . . 2- <br /> i Qv <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE 1$3105 f 0 <br /> I hereby certify that I have read and examined this application and know the same to be true end <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 fhe 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 l L (z_041 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 29L 200 WAC. <br /> -.1151 <br /> Signa re Date <br /> REV1SFD 0&552014 <br />