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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 /> '3 92 5 .-OCA wav GTe .20p <br /> PROJECT ADDRESS n <br /> fNJVCt Cc-- MGtn�:N�A'rnl! f.U. Bcx 132-70 Uv`12CTi LVA 98206 <br /> Owner Mail Address City State/Zip Phone <br /> Prc(UC0c.c Mavgq a itae,-T I`�.0. 130)c13270 �vct-o 7 T LA-,,4 9820(o <br /> 1j Mail Address City State/Zip Phone <br /> DA1A L E.t_EC tOLLC— -1)kA ij)^.0 ALL. Avg F u,:,&-ft- " 9%.101' 4i1 S-?!Fj-1?o <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> OARLEE i CAILQ 8 0 2) -7 Q I LE <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> l6la.6L STauams -2 IA) -LG1 -D-Tii <br /> ds�tvc.hsLa d�_f,,l�l�e�ri�.c�;� <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: ItJ 51 ,,SLC. C ii 11a I I c cr�4� De C,),— 04&—'1 � <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 f <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/am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> tl ho <br /> 5 <br /> �8ioature Date <br /> REVISED 0 8/0 62 0 1 4 <br />