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• 11110 <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 /> 228 SW Everett Mall Way Ever( ick. zok <br /> PROJECT ADDRESS <br /> Goodwill 228 SW Everett Everett WA, 9€ Z(' <br /> Owner Mail Address City State/Zip Phone <br /> same as above <br /> Tenant Mail Address City State/Zip Phone <br /> Lumenal Lighting LLC 21706 66th Avenue West Mountlake Terrace WA, 98043 425-481-5001 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> LUMENLL864LW 21502.88 <br /> State License Number Contract Price of Work <br /> COMMERCIAL Junior Segura <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: Changing out parking lot poles heads and wall packs <br /> around building. <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 +� <br /> I hereby certify that I have read and examined this application and know the same to be true and $ f2:1 '�'�✓ <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 II <br /> performance of construction. That I am authorized by the owner of this property to perform the E Y 512- <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Junior Segura 12/18/15 <br /> Signature Date <br /> 4-7-5J 7 4LoS4- eAgoLoc COC1 <br /> REVISED 320/13 <br />