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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 PC/ /D " SOJt` Qkao/ <br /> PROJECT ADDRESS <br /> 46 <br /> 3000 hRoc�- e/L en aim iei� L)a 990/o/ 3 cw-3y 3 <br /> Ownef Mail Address City State/Zip Phone <br /> C �o� �d .� C° £2JC 9F0/6/ <br /> Tenant Mail Address City State/Zip Phone <br /> Jek4) a _ /S/35 Y2 9t �� « CUa �I s/o6 oo <br /> Electricont ctor Mail Address City State/Zip Phone <br /> c.S2 vd)L 977S9 V GAS <br /> State LicentO Number(required) City of Everett Business License Number(required) <br /> tiQri (J/?S ' 5661 <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 /> C,) <br /> Number of devices(If low voltage) '� <br /> Description of Work to Be Done: c� <br /> 14- l W 6'( /Jett) We '&) O� <br /> �•cl tier"-) tt�wif.r>r ?oa-1 f Yec.vd.nty e Inc e <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> • <br /> I hereby certify that I have read and examined this application and know the same to be true and -9:1 J 0 <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 (s? 3 - 078 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.20 AC. <br /> _41,zzaz,(( <br /> Signature Date <br /> REVISED 08/06/2014 <br />