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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 /> 3 20 5 Icy L-14 e pie-.J EvE4eorr, Wit 18'2-o t <br /> PROJECT ADDRESS <br /> G .1►r• 10 <br /> el min 1'14 ) `1 ftot 3 �.4: 11 r1G br, E11c 'W rd r c C 0��1 <br /> Owner Ma1t,yAddress City State/Zip Phone <br /> /I/ /ti <br /> Tenant/ Mail Address City State/Zip Phone <br /> frsfezT Ei_ecr4ic, 1-1.-c 2_+-72F 233ap P►- 5e MPrPLE muss w qe 3g' <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> Cc- ktSPE6%8833-' &( p1IPA "5"L 2/(/4 I5 <br /> State License Number(required) Cityof E1 drett Business Licens�Nu ber(required) <br /> q ) ( q ) <br /> gc, , n r ct.1 l0 3 R <br /> Proposed Use of Buildi�5g Contract Price of Work <br /> 16-6 y 144 eir LA-u&>{�l1/3490 34.0 5/3.5 <br /> Square Footage(If residential new construction,remodel or addition) Contact Person/Contact Number/Email <br /> reseeofeice 4-ri@ H -;I.com <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: (\IIC,rzt 6 t ' tr 5Sertit I LOI/A(Id(1 ha:5m &_pveat <br /> FEE ob <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1j <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 r r <br /> performance of construction. That I am authorized by the owner of this property to perform the t l <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and J <br /> 296.200 WAC. ^ <br /> �' !/ 02/03/2-015- <br /> Signature Date <br /> REVISED 080612014 <br />