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zo �5L0-3 <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 /> 6 d l Ea.y l ,Ave . <br /> PROJECT ADDRESS <br /> K le ��le Noot Gxot A\je E\Jere* WA '019201 '429-9-2-3-LIC-L-75 <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> WA co a sfc s ( a 103 N�, lig I-" S4 c-too, Red.wL� WM 9 , - <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> 4251-g$t--7c(-Z(:) <br /> Nk t kCQ�d nil ca 25 c 5 0 5 L4 Lf <br /> State License Number(required) City of Everett Business License Number(required)` <br /> Proposed Uge of Building Contract Price of Work <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: IRepka-C.e C{0.-s T Iry xce W1ky\euo <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 5 000 <br /> 1 hereby certify that 1 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 E ) 5 - <br /> work <br /> 15 -work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> nature Date <br /> REVISED 08/062014 <br />