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0 • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 a5 `tom <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.gov <br /> Cfi 5cD CVer �eV1 W ) & tio/(0 C <br /> PROJECT ADDRESS ci <br /> Pzv-ob2 (O«Pcq 2 aCl G'Vel rte 0 (40 j vJ2/e'T� Lt)(/ C?( Co -1 4z5- * 5" -*.3 <br /> Owner �" Mail Address V City State/Zip Phone <br /> Peroba 6c2i(eq, q RTO Cve..rrf( tcr,-4 � 'yr fives � k)41 44c7_04 c 7,$)3S'3 --Fs/4 j <br /> Tenant Mail Address City State/Zip Phone <br /> t•J 2s(i ols i(4 Marwirr c, Zo?,r) )Crp0/4- (iv S) ,ate, WA- C6134( Cz Q4 3z "-3z -&- <br /> Electrical Odntractor Mail Address City State/Zip Phone <br /> LASH A-r "?i, 2&3 07,6 ; <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> 5.z vl 6+e-co e vt-{- <br /> 1 6/ ?-S`p " loG-Lt3b-633z ;6.16,0 ,-1-Q cu '�J fol aizt'"?.c a <br /> Squard Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> q 7,_ 0 ktir ttlyWedi i r\e"64(Ytit ° <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: r i 5 f Z((0490 ci3= e. oe4.01 d(9v/"L P;rc. <br /> e 1,,--0✓I GOv1 I rd (d4VVI <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 i2' <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 the �/� <br /> performance of construction. That lam authorized by the owner of this property to perform the E\ -01.-1.6- <br /> Fv I-'�.6- <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and V <br /> 29.6v200-WA-. <br /> --7 _-� O ( 15/ 15- <br /> Signature Date <br /> REVISED 08/06/2014 <br />