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Jun 20 1310:33a p.1 <br /> • <br /> I I <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 /> • <br /> • <br /> 110. a 1n )ei- Ave <br /> PROJECT ADDRESS <br /> i leu 1 � � 112. 14E 1�Q-r�� ci � �r�Y�i fie , ; z6.17 <br /> Owner Mail Address City . StateOp 1.4..L5 1 42142 Phone <br /> • <br /> Tenant Mail Address <br /> City ' tatef P hone <br /> ��tttc\ +Ie 4 .05 \ e0 Ave SE . X25 �3 , z ;SS <br /> Electrical Contractor Mail Address City State/Fip Phone <br /> State License Number • Contract Price of Work <br /> Uva le kt,rYJ Re -O X C� <br /> Proposed Us�Building Contact Perso i (Plan Review) <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices (If low voltage) . <br /> De ription of Work to Be Done' h�P �� �� <br /> CO,9 qae5 on,3 Oordntti- i, 42_6 314 Co f54+ MehOlr9:) <br /> FEET • co <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1 5- j� .,� <br /> I hereby certify that I have read and examined this application and know the same to be true and . ! `J (J <br /> correct AN provisions of laws and ordinances governing this type of work will be completed ' <br /> whether specified herein or riot. The granting of a permit does not presume to give authority to FERMI# <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 ! l ✓V _ t L_ <br /> ! <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and I ✓V <br /> 296.2.s - . <br /> r. <br /> 4 Signator Date <br /> REVISED 3/20!13 <br />