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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— zv t rJ-e t/eGr,C?s`r atid.. v" <br /> ek1rti ('. were--f,'-.e pS & eve-v-IV •qd <br /> -1 U aupc r� <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> GYtiA ls3 D t ELai 14 err. <br /> Tenant Mail Address City State/Zip Phone <br /> �U LAC_ Cb ('0X "I LIt4--i-Ar..11) L.1 , `I ‘bD s <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> P.CA)\A L r J 0`6 0-1 (: ) `I <br /> State License Number(required) City of Everett Business License Number(required) <br /> '5 t%V� <br /> Proposed Use of Building Contract Price of Work <br /> t el.A .(- J TS-o- -Yrw O.1t rt N..i Lingt,(614,^ <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: C",S/� l�Gl CM: sy 5 9'v'i N oi_ `;p- <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �j; <br /> '1§ <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 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 I am authorized by the owner of this property to perform the E15-00 I I 1 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> PA7 1, 41116 �b <br /> Signature •ate <br /> REVISED 08/06/2014 'a t G -rL� 65-1-0 <br />