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ELEC1IC <br /> AL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857— t.z.1-e ve-K " Lodz.-���,y <br /> e .et erg`{`feps & .v-1'e44- ' id <br /> DCRL1 cu9i <br /> PROJECT ADDRESS <br /> • <br /> A • t7 D 't jC I r7`1 Y C ll c7r U`-)y\ cj 7""). <br /> Owner Mall Address City State/Zip Phone <br /> GziAt<>( V & <br /> Tenant Mail Address City State/Zip Phone <br /> LA;? :L.CZ'll?I L, Pb �3a c G p _ <br /> `f�Z� 11?(�VIJi-i� . 1L � ('�j75 ZZ 20i7i <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> Square Foo �C' t, rJ T Sc-ihti�hty.YL+ ,v,,,j Li NU,4:w1 <br /> 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: CDS -11L/ CM'& ,j,`7' 5/iv i N l: f(,r--1nc;:vLz:1714e-Ni- cif--= <br /> • ) 14:\ ;tet t- :,b0S 3 c_ tvz644 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 $ <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct. Al!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 /> p� <br /> performance of construction. That I am authorized by the owner of this property to perform the E I 5000 - DSO <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Vii <br /> if <br /> Signature fJ Date <br /> REVISED 08/0612014 a I'L C <br />