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• <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 /> Igo z s.1 cvlgc1? w4t wiy <br /> PROJECT ADDRESS <br /> ��ElL f1 wkt- <br /> Owner Mail Address City State/Zip Phone <br /> DG D /1/4-1/),/ <br /> Tenant Mail Address City State/Zip Phone <br /> lvn nonikt 51-6Nl Cotil. I7s5111/010.kr 44. it/ SFtyfir/ crgl o 1ç_.a2.-oleo <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 107/6/ Sto3,w1 3 <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> znrfoittfi <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: 10.1so- Orie Ar0/Sf"TGl( ( /GL 1.t s "m' Q tX-(Er uu4 I.144 5i cJ <br /> pip 3 Qry. ffItk1tcVt 516ff. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105f.�/�C-)0 <br /> I hereby certify that I have read and examined this application and know the same to be true and („9 <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 o <br /> performance of construction. That I am authorized by the owner of this property to perform the E 6 50/— I/ 0 ) <br /> work for which applica ion i made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> (-2o/1 <br /> Signature Date <br /> REVISED 08/06/2014 <br />