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• • <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— Lai w ti.)_e V �-hc w4.. e v <br /> et>,-.(A.i (°. iverg-f--1.e.P5 + 61/- -i'e YUM- <br /> idV <br /> E.;.) .-.), <br /> PROJECT ADDRESS <br /> 1i A i'0:13,/,' 117'f E vt�;.67- l,- \ WZ J <br /> Owner Mail Address City State/Zip Phone <br /> GZAtJl)\I,C00 0:3r-f-5. <br /> Tenant Mail Address <br /> t(��` City State/Zip Phone <br /> Electrical Contractor J I-) • C L 5 (`i ZS "ZZ Zo I Z <br /> /y Mail Address City State/Zip Phone <br /> If..C:1._ <br /> )A t-t 3 t-'"i 07.-z,c;1 y <br /> State License Number(required) City of Everett Business License Number(required) <br /> • Ut)(�ti 425 0 <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage (If residential new construction, remodel or addition) Tr G� ��� r- &- `9vtu''r,.. ,;,,y L-1,44-,(0+1 <br /> . Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: CDS fk-c-71C(t"f-"L 7 SAV;N i✓ r <br /> it,--fv.lLcYtiovt 0--p_ (-iGHrs ) <br /> +ant r,,\,-c.; r U6eit��oS / <br /> Z c-trz- , r <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 5.� <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 /> peuthorized by the owner of <br /> 7- <br /> work for which application Is made and Iormance of construction, That I am comply with the State Contractors Laws 18.27 RCW and to perform the E f j <br /> 296.200 WAC. ` ! — ' ) <br /> ifitt, <br /> 4.,4, . <br /> OG I i bit 5 <br /> Signature r <br /> SJ Date <br /> REVISED 00/06/2014 73 r t L 773 e_N , <br />