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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 Li—3 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org & ISD q 4'1 2 <br /> i‘eryc-1:4, UKr dpoclitie,- f <br /> 5 a 25 — <br /> PROJECT ADDRESS / <br /> o re/ricv f Cort Tfoe7cvr R l g 41- Rem ode e f / 110'16 /VA( 57` 57.2.0 <br /> Owner Mail Address City State/Zip Phone <br /> 6e//e' re. ( /�/4/' 9OW7 <br /> Tenant r Mail Address City State/Zip Phone <br /> /c,/11e tlrct`r, c 7_,4 f753 ? a`°71-/ rS( i7Zr// GLS X10/2 /e- 't7f <br /> Electrical Contractor Mail Address City State/Zip Phone 5 5 , <br /> 4i06z §,tvamegt , I31ts ) <br /> • <br /> State License Number(required) City fEverett Busin=ss License Number(required) <br /> Pr coo <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 /> Number of devices(If low voltage) <br /> Description of Work to Be Done: /t 57o'/f,h 3, 5u/77cl r46,44,/f 7` CrfliI i T f a//u Oy5 <br /> l o n 0 -Ifrld,-time/ ,Zt aet o 'f o1 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 7� (-7 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 <br /> f't <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. / <br /> acs4rec �d-�a✓de - y/ 040/ <br /> / 5 <br /> REVISED 08/06/2014 <br />