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4 <br /> Mdn � <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 /> S1° 6 pi, S_i€. 6-vt=r-a-r-'r <br /> PROJECT ADDRESS <br /> F-' 14'A ('u 9k.x I `l '7 Et/E .FTT" [,—)P\ , Ci bb 2 u/ <br /> Owner Mail Address City State/Zip Phone <br /> Fvt£w rpr <br /> Tenant <br /> A Mail Address City State/Zip Phone <br /> �"v DMA Lt4(Z. e LeZt1Zt C, /0 OC1C `lb? giYI, u`i N 0 1 njA 7 t i t 3 (`i Zr-/D t i.Zei Z <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> L l .;b, L j D 2-hL i y <br /> State License Number(required) City of Everett Business License Number(required) <br /> Qns rrvt,E►i 4 `I5►vOT,,`%- <br /> Proposed Use of Building Contract Price of Work <br /> J Git,El-T)n> T'36- -Axt041 MJLerd.,)LINI: <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email Lsn <br /> (yn-r) iyS—�ioi <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: Cc 5v Cr-t /C-v1.-11-6-1 r&rt.�lcey1T-r;T c(- 1,1 uki .f-- FIA t-14r(rS <br /> t3AT1.i (4.05 NfH'1 Iii , T- S�h►TS <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 l 2—F000 <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 <br /> performance of construction. That I am authorized by the owner of this property to perform the E I LH _ O ) C� <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and I <br /> 296.200 WAC. <br /> „fiedvr. <br /> Signature • Date <br /> REVISED 08/06!2014 <br />