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425-252-1666 c.m.heating 14:13:41 10-16-2015 2/4 <br /> ELECTRIPAL PERMIT APPL ATION <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 /> SIA ease Wk <br /> PROJECT ADDRESS <br /> 11(\i i Q [ �D SO, K RSe WA*/ >°- ' DJI9 qg ega3 Qgo3J4 agd- <br /> Owner Mail Address City state/zip Phone <br /> Tenant Mall Address City State2ip Phone <br /> C.P ge&fi nq l n1$5r&r l iA90,9 e\bert W Pt g 8?.o 1 422s 2Sci 1.06140 <br /> Electrical Contractor Mail Address City State/zip Phone <br /> MN- 4g-17 o► ooag <br /> State License Number(required) City of Everett Business License Number(required) <br /> *as 0 .CD <br /> Proposed Use of Building Contract Price of Work <br /> teASev BA itQ S 1�-H4 2., -2c -gSso <br /> Square Footage(If residential new construction,remodel or addition) Contact Peson/�ct Number/Er.n ii �m <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: ��aPc/'J,,cl ik ere <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 '475-D d� <br /> I hereby certify that I have read and examined this application and know the same to be true and 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 PERMIT# <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 15-101'44 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> • <br /> Signature 11 (2 <br /> DateIt) <br /> REVISED 08,062014 <br />