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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 /> 2 5 2 Z 9 Aae- eix Loi <br /> PROJECT ADDRESS <br /> CIA(k N&b e , S5IL 1 ilfrar i erest w14 ` Wt "Zs 3ss1)ti <br /> Owner Mail Address City State/Zip Phone <br /> Tenant pin Q � Mail Address City State/Zip Phone <br /> (? k U wets ) z sC Z a n Afes 47111 L-f f G✓A 5, z o Z S-5 rfi1ir <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <br /> / k1 i3ed_ b_ f - ✓S 7 GGU <br /> Proposed Use of Building contract Price of Work. <br /> frit �w ML's- 'Z1-3sf- ) 311 <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: /111 k r I3ed ro -% / l3 A. 4t0Y� a: A <br /> FEE (, <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 7 500 <br /> I hereby certify that 1 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 O — <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> 130 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> •5. 4 - <br /> gnature Date <br /> REVISED 08/06/2014 <br />