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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 01S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 :I -k <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> I :-OO I 3441 S - Eucrc+-1--, /04 1S2o 1 <br /> PROJECT ADDRESS <br /> R'ou <br /> f e i0.,4I Alai c. . ( )?00 13 64 Ev6tC4-1- WA- TgZ6/ 24, ZcOa <br /> Owner pp Mail Address City State/Zip Phone <br /> Pro✓i cxC C <br /> �e5io ' .ileAC 1 17-OD G-1-k 5f- crcGtiA 2.bi-2aOO <br /> Tenant Mail Address City State/Zip Phone <br /> 1J' t E 1 etif e'o 04g So40- ce -1-(L k)(4 i s IO , 2�4-'f 36-sZoo <br /> Electrical Contractor Mail Address City State2ip Phone <br /> UCGAEC.E51(2.MO OYj`i L{ <br /> State License Number(required) City of Everett Business License Number(required) <br /> t4C6 4 tt 53000 <br /> Proposed Use of Building Contract Price of Work <br /> SC-tacietr .ld 20 -CS St"11.36, <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact b Number/Email <br /> � c t <br /> Q4on• Sootiv.stee c LiEeRt Cori <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: itbOk-ut> OC L/ O S (.i i r� o r �- 1 <br /> f ati. c. (3 o n LLJdi o r, 8 � <br /> Ditt9r odic min ER <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 1 CjO <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 <br /> performance of construction. That I am authorized by the owner of this property to perform theE 1602-03 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �L 215 <br /> Signature Date <br /> REVISED 08/06/2014 <br />