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low <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 /> ,2,6/5- 111161144,W) <br /> PROJECT ADDRESS <br /> �Z S <br /> ItI64 o,J /0E7,-eot 65ur! //2 S c��Tk ST .fw �yE'X&7 G--11/F 9$.t o 3 353- 970/ <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> �2 <br /> 37- <br /> :7 Yll <br /> r:7Yil <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> G11-11rZ,rec iT�"/G 0/9 1�4'5 ;21" <br /> State License Number(required) City of Everett Business License Number(required) <br /> !'c./EG �,OD•¢i ids ��S/�.c�s�,e-. '�S7 9� <br /> Proposed Use of Building Contract Price of Work <br /> o - <br /> L/�tJ/TEA.F�.G <br /> Square Footage(If residential new construction, remodel or addition) Contact Person/Contact Number/Email <br /> J <br /> Number of devices(If low voltage) 1 <br /> Description of Work to Be Done: ��tI��Q liQoy�lQ c/t /Q/AAr, l41;ee- �lr SA, <br /> 4,DD i/vE 7,4 AA4 AP2 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify that I have read and examined this application and know the same to be true and V <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/am authorized by the owner of this property to perform the E f'J 01F^ O 2 <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Sfgnalure Dat <br /> REVISED 0810612014 <br />