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9 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.everettwa.gov <br /> 2500 Cwt4 Q'� <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> �e �ev5©n L&VA 1500 UAY F-jeie--4 �AJA IM63 <br /> Tenant Mail Address City State/Zip Phone <br /> VvlE61SrC%�°tC� obwvtitl,{UIICC� i22�d�✓S`�c1 M4 vl! A Md ?q & <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> DI M r�►y GZ I 10 0-✓v 0 <br /> State License Number(required) City of Everett Business icense Number(required) <br /> Proposed Use of Building Contract Price of Work 3 (P D"�1Z�I ^(V <br /> 1b. 0 K4 <br /> Square Footage(If residential new construction, remodel or addition) Contacf P rson Contact Number/Email <br /> 2- <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: 4OGt <br /> J )' 1 I <br /> l�l.4crrrl m- S ea ke �D I�D�t`4 6`e <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �Oco <br /> � <br /> /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/am authorized by the owner of this property to perform the l 5 o -o <br /> work for which application is made and l comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 0,�&V (e/7 Za IS— <br /> Signa ure Date <br /> REVISED 08/06/2014 <br />