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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.gov <br /> 2312 We -k• S (' o Rci <br /> PROJECT ADDRESS <br /> re-)M n-ALA('i y I r�nSN't <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> VCi l lsz7/ C .ar,�� I I(70 "l esr'y I C r�-e._ PSK w ' v ear P i-t W A\ 1 7_61 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 05353 <br /> State License Number(required) City of Everett Business License Number(required) <br /> 41t t� b� <br /> te r-'--r6,\�� — <br /> Proposed Use of Building Contract Price of Work <br /> ncics0-1 r• - C -56c°-gH0- <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> L aacz.r 1C) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: S' <br /> � t`c71l}"ct-1an. c W <br /> Oo1'rc . C�irh-��} :iry',, cokt fu7 <br /> (00 e 1-5 G nCi F Cr t 5, 4 jcS ( C i' ti:1* For G_• rt-r- l <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 lY ( 1 O <br /> tJ 1 / <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 they <br /> performance of construction. That I am authorized by the owner of this property to perform the E `+�bye 113 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and (.1 <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 08/06/2014 <br />