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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.org <br /> 00. reoz �[ <br /> C T L e_v• <br /> PROJECT ADDRESS <br /> P lk cy 19\.tc-c-tA tt.a ;3 t 7 R<.c & 1 u 4 y2ss-2.31—C /t/ <br /> Owner Mall Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> I-.Pe.13 J L�S�=C k\L SNC— S.s.vs lr it(44 W 4 °l <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> • <br /> LASWE�:L 1g4Y,i= (-6State License Number(required) City of Everett Business License Number(required) <br /> fE42-01 <br /> 4 CO <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) <br /> Description of Work to Be Done: 01/SC- crit lnl H Z\ M • /Ot2 J 0Zr S <br /> ti j l� A10 Sal D t`Tf sa-a i262- 1 L ) ttu t-tkl .w/1,/ <br /> cuL_) JJ <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 *t0.°t) <br /> - <br /> I hereby certify that I 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 elo - 1019 <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 98.27 RCW and <br /> 296.200 WA . <br /> )P'/D I <br /> Signature Date <br /> REVISED 08/06/2014 <br />