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S <br /> ELECTRICAL PES IT APPUICATICO <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 /> HO SEEuero-Al c\nat111 <br /> PROJECT ADDRESS <br /> 1(f v S Cver Lk. rota' (4 L Veq-4/- bucL 982 c' <br /> Owner Mail Address City ' State/Zip Phone <br /> Tenant Mail Address City State/Zip j 0,27 73g azp <br /> -6t_UI3 Stfs N\k) Po. Gox 10( C �icekc v & t2r 970/5 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> • <br /> State License Number(required) City of Everett Business License Number(required) <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: �C/ ' /� RC:CLAA <br /> M <br /> Yyin-� YS <br /> wevyvv),- e-C y► a 5 1 5 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 $i 200 o°C) <br /> I hereby certify that!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 5 D 9) - Q 01-1 <br /> work for which application is ma and!comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> &f3/`S <br /> Signature Date <br /> REVISED 08/06/2014 <br />