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04/10/2016 21 : 55 • #0265 P. 001/002 <br /> • <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 /> AVE <br /> PROJECT ADDRESS <br /> Y21 <br /> C Ll l fup-I Vas L/ tom©Atli )(di/ f/243 . f o Co- <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Addrebs City State/Zip Phone <br /> Ei'-M1400 it-S R o N .. iffeim/7- w wesa 9 2/ <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> z-110 0 C <br /> 3 - 3 <br /> State License Number(required) City of Everett Business License Number(required) <br /> crFll.� <br /> Proposed Use of Building Contract Price of Work <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) n <br /> Description of Work to Be Done: k L 4-, iv1 _ -/sta g/ <br /> A-i-7Tnh ,zttrait000. sr/T.-Ay/6e <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE 15 3106 `t��'1 1^`09 <br /> I hereby certify that I have read and examined this application and know the same to be true and I,�J <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 PFRMTT# <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 i I „Q(-1- D r„I{/ <br /> work for which app 'cation is made and I comply with the State Contractors Law 18.27 RCW and l(J l Vit <br /> 296.200 W• <br /> rte/ _4 / �i <br /> 9-tura / •ate <br /> REVISED 0808/2014 <br />