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_ TiA7\ • ilYteettl <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 /> L'i4DEA s-c- E Tr WI 9$20I <br /> PROJECT ADDRESS <br /> f.1 -IZEIL_A ./n1 _ l(rRt0 <br /> Owner Mall Address City Slate/Zip Phone <br /> Tenant Mall Address City State/Zip Phone <br /> 425-7181 I.9 <br /> C-n <br /> A- Ve EkiCNI 1W5 2o52-6 trgr t,k) L-1& vi-bob 1 .88336 <br /> Electrical Contractor Mali Address City State/Zip phone <br /> TWOMSPCT. 016—ei <br /> i State License Number(required) City of Everett business License Number(required) <br /> RPF MS gEoODEL.. 32S ,oa_ <br /> Proposed Use of Building Contract Price of Work <br /> • Mirh4A4 WALT ate! LI25-z i B- (7 -} <br /> Square Footage(If residential new construction, remodel or addition) Contact PefaonIContact NumbertEmall <br /> /A <br /> Number o devices (if ow voila; e) <br /> Description of Work to Be Done: ___geMov " -RRTT /14,4,<./ L1 f L F(X 1 <br /> FEE (� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 g{ 15. <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct All provisions of laws and ordir;ancos governing this typo 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 1160 -0P2..4 <br /> work for which application Is made and i comply with the State Contractors Law 18.27 RCW and <br /> 296,200 WAC. <br /> 5-19- (5 <br /> Ignature Date <br /> REVISED OVIA,2014 <br />