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ELECTRICAL PERMIT AP (CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — La/tot•)- +%GK,. `i S.i) y V <br /> PROJECT ADDRESS <br /> • <br /> • <br /> Owner Mall Address City State/Zip Phone <br /> '`ilAINl) tElA) 11,11i213. <br /> Tenant Mail Address City State/Zip Phone <br /> Y1 <br /> Dt,tE12i-71ZlG Pb 13a Ligt1 Vt t�i�a��,� L. `I tb3 (L/z5 etZ- 1Z- <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> r- 30(6 L11 `i <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> 77.-c&M`11: N 1=4-6-- DNt.411. 1'11rJ LINV,4:.•11/✓ <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 �tyl1L C=�� �n N rj <br /> p t��7 5 V i 1��0"1<-c Z'L9 t"7vt- i.'7.1. C <br /> 1L17tiL•>l / t <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 Va <br /> I hereby 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 will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERM1T# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That l am authorized by the owner of this property to perform the E I J(J I -U <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and �J <br /> 296.200 WAC. <br /> i <br /> / <br /> 4/N-'4?/. 7 /211-5- <br /> Signature ( 1 Date <br /> REVISED 08/06/2014 ' <br />