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Sep. 25. 2015 9:41AA No. 6055 P. 1 <br /> i 0 <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.averettwa.gov <br /> gJ`— 1r/ i:i' . _ _ . ./ - . <br /> • <br /> PROJECT ADDRES <br /> '" 1A e. 1 1/g 1St/02 <br /> Owner Mall Address City State/Zip Phone <br /> L•/e.L♦ A •.5 .. , ei,.! . .i `�U � 6J/4 9 gZ.D e' Z1Z{3M4/ j <br /> Tenant Mail Addressr City State/Zip Phone <br /> • Electrical Contractor Mail Address City State/Zip Phone <br /> Key 1c/ 72 /Zu to / Z 7 <br /> State License Number(required) City of Everett Business License Number(required) <br /> 41-atj Sa./._,__S IS" G6- o00 <br /> Proposed Use of Building C tract P Ice of Work 25,5 7z 751.Z_ <br /> r_sd2 iy e‘/--(ii)k Mee-Lai,' <br /> ife_ad.coin <br /> Pierson/Contact Square Footage(If residential new construction,remodel or addition) Contact Number/Email <br /> Number of vices(If low voltage) <br /> Description of Work to Be Done: p ys iZa..(*/ stye- p e.....'t. e4424.41case. f,Qiwi3O <br /> 1111511MRII: / ., <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 AV �� <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 <br /> work for which application is made and I comply with the State Contractors Law 16.27 ROW and <br /> 29621 AC, G <br /> � ! -'-4' , <br /> _Iz <br /> Signature Date <br /> REVISED 09/08/2014 <br />