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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.arg <br /> 2c\ 3 c 12,0c.1.E 12. Ave'. <br /> PROJECT ADDRESS <br /> 1 4'1- 197--el.13y7t,PPIA CI'02414, 2°I' . {Yer-6ux pJe, EA/612e-TT, WA. 16201 <br /> Owner Mail Address City State/Zip P one <br /> 425-25$-�t9 I <br /> Tenant Mail Address City State/Zi Phone <br /> z5 - GZ.Z�� <br /> PC El F-ddkL E_L.Ez'6y__&c..v t LE 42)()4 _t , 5 tiUZ 6a.yi LJA °t IL:57- <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> RcELESY2 2_SDF * W/ (405 <br /> State License Number Contract Price of Work <br /> CNUCI-k Clan <br /> n Ct^/ iClE.) K� 1Z i), Lew ys <br /> Proposed Use of Building Contact Person (Plan Review) <br /> 4-G so. r <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: <br /> tiEv) Ze n A -A d5 SSD\! `11 Lir.: t 0 L L Ck-2\L, <br /> an am 4- 3ub P � <br /> Fir <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that t 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 PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That t am authorized by the owner of this property to perform the E1400- 17 ( <br /> work for which a plication is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Q . <br /> VI cob _p/j4A.11 E-2_LI,-i, ),/ <br /> Signature Dated <br /> REVISED 3/20/13 Li 0 ,53 <br />