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05/05/2015 10:34 4254897996 HOME RUN ELECTRIC PAGE 02/02 <br /> • <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 /> 10 .3a (44 Of Se, ev rr wf qg <br /> PROJECT ADDRESS <br /> (uhectVhi (ak3o to 51— N•� 14k Saic s w gtasgr <br /> Owner Mail Address City State/Zip Phon <br /> A) <br /> Tenant Mail Address City State/Zip Phone <br /> WOW bE c Lit- P-0. &)( art 60A-tell wa oto-! zoshmtton/ <br /> Electrical Contractor Mall Address City State/Zip Phone <br /> irnag .ea74.Ka OLA U31 <br /> State License Number(required) City of Everett Business License Number(required) <br /> o[e - r C v rr a Sgt 300. <br /> Proposee Use �of Building Contract Price of Work <br /> kcViaet Skvt A Zoe- W'901 <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: Te.X1N.V c2.16 o v' j - <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 5 <br /> 0 w <br /> l 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 �OS- O 21.0performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which appliceflon.is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> oil • <br /> /12:4„ ,Oti efz,115 <br /> Signature Date <br /> REVISED 0806/2094 <br />