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Jan. 21. 2016 9:48AM No. 1664 P. 5 <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 /> PROJECT ADDRESS <br /> Owner Mall Address City Stale/Zip Phone <br /> Tenant Mail Address City Stale/Zip Phone <br /> rr .�-y, ! - r;r`t ,�. AveL• [.r. l . /: I t; t?(.2;".- (�......,_^^._.f`-tc: -- <br /> . C��� _._E.. .'C � � -. ..air.'". ` � � � ��rl. ., � J � ._l <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 616762 <br /> State License Number(required) City of Everett Business License Number(required) <br /> -.4 etl G`:L. .:. r �. _V• <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 Of low voltage) • <br /> • <br /> r <br /> Description of Work to Be Done: ,; !_(_.._...f �� i(t, C:- '.- <br /> FEE W.....,.,_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 itkl O <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 he 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 cf any other state or local law regulating construction or the I tet �� <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contactors Law 18.27 RCW and <br /> 296.200 C. <br /> • <br /> f/74 n <br /> Signature Date <br /> kF.V!SCD0arosnO14 <br />